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Integrating Primary Care Practices and Community-based Resources to Manage Obesity
Tool 12. Sample Punch Card
Table of Contents
- Integrating Primary Care Practices and Community-based Resources to Manage Obesity
- Acknowledgements
- Support
- Foreword
- Oregon Rural Practice-based Research Network (ORPRN)
- Why Was This Guide Developed?
- Quick Start Guide
- Introduction
- Chapter 1: Attaining Zoning and Building Permits
- Chapter 2: Building and Assessing the Clinic Foundation
- Chapter 3: Getting Patients Excited About Crossing the Bridge
- Chapter 4: Building the Community Foundation
- Chapter 5: Crossing the Bridge and Returning
- Chapter 6: Reflections on the Critical Elements for Successful Bridge Building
- References
- Resources
- Tool 1. Staff Meeting Discussion Guide
- Tool 2. Chart Audit Form and Instructions
- Tool 3. Clinical Care Observation Guide
- Tool 4. Patient Waiting Room Survey
- Tool 5. BMI Protocol Template
- Tool 6. Worksheet: Establishing Protocols for BMI Screening
- Tool 7. Documenting the Conversation in Your Charts
- Tool 8. Sample Community Inventory Form
- Tool 9. Sample Prescription Pad
- Tool 10. Sample Brochure
- Tool 11. Sample Poster
- Tool 12. Sample Punch Card
Publication: 14-0043-EF
Page last reviewed May 2014
Page originally created May 2014
Internet Citation: Tool 12. Sample Punch Card. Content last reviewed May 2014. Agency for Healthcare Research and Quality, Rockville, MD.
https://www.ahrq.gov/ncepcr/tools/obesity/obpcp-tool12.html
