Patient Recruitment Tracker Date contacted Health & Comfort system Recruiter Final Applicant Patient last Patient first Contact info: Contact info: Contact info: Insurance Chronic Date Recruiter speaking in Time patient Interest in notes disposition ID name name Address email Phone Age Gender Type Disease mailed initials group setting commitment experience project Add to list Ethnicity 1 Doe John 123 Park St Phone: 65 M W Medicare TBD 11/01/17 11/12/17 Yes/No/ Yes/No/ Yes/No/ Yes/No/ Yes/No/ [Notes on Eligible, Seattle, WA EK JM Maybe Maybe Maybe Maybe Maybe candidate etc… 98111 demeanor, personal circumstances that affect participation]
Patient Recruitment Tracker Applicant ID Patient last name Patient first name Contact info: Address Contact info: email Contact info: Phone Age Gender Ethnicity Insurance Type Chronic Disease Date mailed Date contacted & Recruiter initials Comfort speaking in group setting Time commitment Health system patient experience Interest in project Add to list Recruiter notes Final disposition 1 Doe John 123 Park St Seattle, WA 98111 Phone: 65 M W Medicare TBD 11/01/17 EK 11/12/17 JM Yes/No/ Maybe Yes/No/ Maybe Yes/No/ Maybe Yes/No/ Maybe Yes/No/ Maybe [Notes on candidate demeanor, personal circumstances that affect participation] Eligible, etc…