Ambulatory Patient:: Teach-Back Self-Evaluation and Tracking Log

Form Template

Use the Teach-Back Self-Evaluation and Tracking Log mobile app to evaluate and document the Teach Back Method.

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The app records: Patient ID, Items to do or remember, was teach back used, results, clarification needed, patient perceptions, your assessment, and what to do differently next time.

While this Teach Back Method app is dedicated to ambulatory patients, it can be customized for other scope of practice. Use of this tool will assist in teaching improvement, patient education, and a better relationship between patients and medical staff.

This app can be downloaded to an iPhone, iPad, or Android device. All medical records are securely stored in the GoCanvas Cloud and can be printed or emailed as a PDF if you want to share it with others.

  • Submission Editing
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  • iPhone
  • iPad
  • Android
  • Windows
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  • Quickbooks
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  • Google Docs
  • Dropbox
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Dave Kramer, PennLine Service

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