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Multiple Self Management Behaviors
- This section includes materials related to multiple self management behaviors. Because many self management behaviors are interrelated, one document may address multiple behaviors (e.g. nutrition and physical activity or goal setting and problem solving). Such materials are listed here and organized by the nature of their use.
Assessment Materials, Forms & Instruments
Are You Ready? Brochure (Dept. of Family and Comm. Health/Marshall University)
BCS Patient Questionnaire (Open Door Health Center)
Behavioral Health Assessment Tool (La Clinica de La Raza)
Behavioral Health Assessment Tool Spanish (La Clinica de La Raza)
Behavior Worksheet (Galveston County Health District)
Case Management Assessment Form (Open Door Health Center)
Case Management Check-in Form ( Dept. of Family and Comm. Health/Marshall University)
Case Management Follow Up Form (Open Door Health Center)
Case Management Intake Form (Minneapolis American Indian Center)
Diabetes Clinical Form (Minneapolis American Indian Center)
Diabetes Group Visit Form (St. Peter Family Medicine Residency)
Diabetes Provider Visit Form (St. Peter Family Medicine Residency)
Diabetes Support Group/ Self Management Class Feedback Form (Center for African American Health)
Lifestyle Survey (Minneapolis American Indian Center)
Low Literacy Patient Assessment Tool 1 I 2 (Open Door Health Center)
Medical Assistant Diabetes Survey (St. Peter Family Medicine Residency)
Participant Registration Form (Gateway Community Health Center)
Participant Registration Form Spanish (Gateway Community Health Center)
Patient Assessment Form (Dept. of Family and Comm. Health/Marshall University)
Patient Assessment Form (Gateway Community Health Center)
Patient Assessment Form Spanish (Gateway Community Health Center)
Patient Information Sheet English/Spanish (Open Door Health Center)
Program Intake Form (Campesinos Sin Fronteras)
Program Intake Form (Galveston County Health District)
Project Participant Assessment (Campesinos Sin Fronteras)
Project Participant Post-Test (Center for African American Health)
Project Participant Post-Test (Richland County Department of Health)
Project Participant Pre-Test (Center for African American Health)
Project Participant Questionnaire (Richland County Department of Health)
Questions for People with Diabetes (Galveston County Health District)
TTM Patient Questions (La Clinica de La Raza)
Type II Diabetes Standing Orders (MA Planned Visit) (St. Peter Family Medicine Residency)
Patient Education Material
Diabetes Self Management Faith-based Overview (St. Peter Family Practice Residency)
Live the Life! Control Your Diabetes English/Spanish (La Clinica de La Raza)
Key Health Messages (Open Door Health Center)
Patient Education Material English/Spanish (Galveston County Health District)
Patient Education Material English/Spanish (Gateway Community Health Center)
Patient Health Record Book (Dept. of Family and Comm. Health/Marshall University)
Self Assessment and Action Planning Guide: A1Cs, Sick Days, Feet, and Flu (Dept. of Family and Comm. Health/Marshall University)
Self Management Goal Setting Tri Fold English (Community Health Center)
Self Management Goal Setting Tri Fold Spanish (Community Health Center)
TTM Patient Brochures on Checking Blood Sugar (La Clinica de La Raza)
TTM Patient Brochures on Checking Blood Sugar Spanish (La Clinica de La Raza)
TTM Patient Brochures on Taking Medicine (La Clinica de La Raza)
TTM Patient Brochures on Taking Medicine Spanish (La Clinica de La Raza)
Tribally-Tailored Diabetes Brochures 1 I 2 I 3 (MT-WY Tribal Leaders Council)
You Can Do It Poster English (Community Health Center)
You Can Do it Poster Spanish (Community Health Center)
Program Management & Implementation
6-Session Diabetes Self Management Curriculum (text) (Community Health Center)
6-Session Diabetes Self Management Curriculum (slides, sessions 2-6) (Community Health Center)
6-Session Diabetes Self Management Curriculum Spanish (slides) (Community Health Center)
Barriers Identified for Diabetes Self Management (Open Door Health Center)
Barriers to Diabetes Self Management (Minneapolis American Indian Center)
Case Management Check-in Form (Dept. of Family and Comm. Health/Marshall University)
Case Management Intake Form (Minneapolis American Indian Center)
Certified Diabetes Educator Guidelines (Gateway Community Health Center)
Diabetes and The Family Curriculum (Campesinos Sin Fronteras)
Diabetes Clinical Form (Minneapolis American Indian Center)
Diabetes Provider Visit Form (St. Peter Family Medicine Residency)
Goal Setting Contact Sheet (La Clinica de La Raza)
Goal Setting Form (Gateway Community Health Center)
Program Intake Form (Galveston County Health District)
Self Management Goal Tracking Sheet (Community Health Center)
Take Action: Managing Blood Sugar Lesson Plan, Student Material and Log (Galveston County Health District)
Take Action: Managing Complications Lesson Plan and Student Material (Galveston County Health District)
Take Action: Managing Medication Lesson Plan and Student Material (Insulin) and Student Material (Oral) (Galveston County Health District)
Take Action: Sick Days Lesson Plan, Student Material, Workbook and Record Worksheet (Galveston County Health District)
Take Action: What is Diabetes Lesson Plan, Student Material, Provider Questions, and Record Worksheet (Galveston County Health District)
Topic Form (Community Health Center)
Type II Diabetes Standing Orders (MA Planned Visit) (St. Peter Family Medicine Residency)
Weekly Diabetes Class Curriculum Session 1 and Session 2 (Open Door Health Center)
Staff Training Materials & Methods
Certified Diabetes Educator Guidelines (Gateway Community Health Center)
Diabetes Self Management Education Manual (Montana-Wyoming Tribal Leaders Council)
Family Medicine Orientation (Galveston County Health District)
General Diabetes and Self Management Information (Galveston County Health District)
Medical Assistant Diabetes Survey (St. Peter Family Medicine Residency)
Medical Assistant Education and Training Curriculum (St. Peter Family Medicine Residency)
Resident Training: Diabetes for the Primary Care Provider, Part I and Part II (St. Peter Family Medicine Residency)
Template Recruitment & Marketing Materials
Class Brochure (Center for African American Health)
Diabetes Self Management Class Flyer English (Holyoke Health Center)
Diabetes Self Management Class Flyer Spanish (Holyoke Health Center)
Program Brochure (Minneapolis American Indian Center)
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