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* 1. Name of Practice

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* 2. Practice Contact: Name and Email Address

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* 3. Practice Location: City and State

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* 4. Practice Demographics [Please select the most appropriate response.]

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* 5. Number of Physicians

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* 6. Number of Advanced Practice Providers

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* 7. What tools did your team deploy to improve the number of referrals for screening colonoscopies and for colonoscopies post positive DNA FIT or FIT tests? [Please select all that apply.]

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* 8. Please share any other interventions your team deployed.

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* 9. Number of patients aged 45 and older requesting referral for screening colonoscopy:

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* 10. Number of these patients who completed screening colonoscopy

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* 11. Enter the conversion rate (completed screens/referrals)

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* 12. Number of patients aged 45 and older who had an appropriate indication for FIT DNA* and had a positive FIT DNA test requesting referral for colonoscopy
*Appropriate indication for FIT DNA is patients aged 45 or older without symptoms, without prior colorectal cancer or polyps, and without any of the factors that define high-risk screening.

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* 13. Number of these patients who completed colonoscopy

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* 14. Enter the conversion rate (completed colonoscopies/referrals)

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* 15. b'Number of patients aged 45 and older who did NOT have an appropriate indication for FIT DNA* and had a positive FIT DNA test requesting referral for colonoscopy
*Appropriate indication for FIT DNA or FIT is patients aged 45 or older without symptoms, without prior colorectal cancer or polyps, and without any of the factors that define high-risk screening.'

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* 16. Number of patients aged 45 and older who had an appropriate indication for FIT* and had a positive FIT test requesting referral for colonoscopy
*Appropriate indication for FIT is patients aged 45 or older without symptoms, without prior colorectal cancer or polyps, and without any of the factors that define high-risk screening.

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* 17. Number of these patients who completed colonoscopy

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* 18. Enter the conversion rate (completed colonoscopies/referrals)

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* 19. Number of patients aged 45 and older who did NOT have an appropriate indication for FIT* and had a positive FIT test requesting referral for colonoscopy
*Appropriate indication for FIT DNA or FIT is patients aged 45 or older without symptoms, without prior colorectal cancer or polyps, and without any of the factors that define high-risk screening.

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