Resources

General Administration

This section includes materials useful for the general administration and implementation of self management programs in clinic and community settings. Materials are organized by the nature of their use.

Assessment Materials, Forms & Instruments

• Case Management Assessment and Follow Up Form
• Case Management Check-in Form
• Case Management Intake Form
  
• Diabetes Clinical Form
  
• Diabetes Group Visit Form
  
• Diabetes Provider Visit Form
• Medical Assistant Confidence Level Survey
• Medical Assistant Diabetes Survey
  
• Patient Assessment Form
  
• Patient Assessment Form Spanish
  
• Patient Information Sheet English/Spanish
• Program Evaluation
• Program Evaluation Telephone Survey
• Program Intake Form
• Program Intake Form
• Project Participant Assessment
• Project Participant Post-Test
• Project Participant Pre-Test
• Project Participant Questionnaire
• Resident Faculty Confidence Level Survey
• Type II Diabetes Standing Orders (MA Planned Visit)

Program Management & Implementation

• Barriers to Diabetes Self Management
• Case Management Check-in Form
  
• Case Management Intake Form
• Certified Diabetes Educator Guidelines
  
• Community Action Plan for Self Management
  
• Community Health Worker Patient Phone Interview Script
  
• Community Health Worker Roles and Responsibilities
  
• Depression Screening and Follow Up Flow Chart
  
• Diabetes Clinical Form
  
• Diabetes Provider Visit Form
  
• Diabetes Visit Protocol
• Full Circle Diabetes Program Resource Toolkit: Your Guide to Successful Program Implementation
  
• Group Medical Visit Consent Form
• Guide to Stages of Change Interventions English
• Guide to Stages of Change Interventions Spanish
• Healthy Coping in Diabetes: A Guide for Program Development and Implementation
• Holistic Program Planning and Evaluation Tool
  
• Lay Health Educator Manual
• Move More Replication Guide
  
• Patient Flow Sheet
• Policies and Procedures for Referring Patients
• Program Intake Form
  
• Promotora Policies and Procedures
• Self Management Education Tracking Form
• Self Management Goal Tracking Form
  
• Self Management Goal Tracking Sheet
  
• TTM Practical Guide for Providers
  
• TTM Provider Cards
  
• Type II Diabetes Standing Orders (MA Planned Visit)

Staff Training Materials & Methods

• Certified Diabetes Educator Guidelines
• Effective Strategies to Motivate and Encourage Healthy Lifestyle Changes
  
• Facilitating Group Visits
• General Diabetes Information
• Group Medical Visit Starter Kit
• Full Circle Diabetes Program Resources Toolkit: Your Guide to Successful Program Implementation
• Lay Health Educator Manual
• Medical Assistant Confidence Level Survey
• Medical Assistant Diabetes Survey
• Move More Replication Guide
• Promotora Policies and Procedures
• Resident Faculty Confidence Level Survey