Evidence-Based Recommendation Form
Please provide all relevant details to support an evidence-based recommendation. Complete each section as thoroughly as possible.
Context or Scenario
*
Key Question or Issue to Address
*
Relevant Background Information
*
Type of Evidence Provided
*
Published Research
Expert Opinion
Case Study / Example
Systematic Review
Other
Source of Evidence
How would you rate the strength of the evidence?
*
1
2
3
4
5
Assessment of Alternatives
Rows
Effectiveness
Feasibility
Risks
Alternative 1
1
2
3
Alternative 2
4
5
6
Alternative 3
7
8
9
Agreement with Proposed Recommendation
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Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
Summary of Recommendation
*
Additional Comments or Considerations
Submit Recommendation
Should be Empty: