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Data Collection Forms 2013

The newly revised Chronic Disease Self-Management Education Program data collection tools and procedures from the Administration for Community Living and National Council on Aging are listed below. Please begin transitioning to these new forms and begin reporting the new data elements by January 1, 2014.

Workshop leaders are to read the standardized script to participants about the purpose of the data collection and the confidentiality of their responses. Participation is voluntary and a decision to not provide data will NOT affect program participation.

Attendance Log (docx)

Microsoft Office Word Document

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Group Leader Script - English (docx)

Microsoft Office Word Document. Last revised 11/18/2013

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Group Leader Script with logos - Spanish (docx)

Microsoft Office Word Document. Last revised 11/18/2013

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Non-Disclosure Agreement (docx)

For Master Trainers and Lay Leaders that collect data at workshops and trainings, please give your signed non-disclosure agreement forms to your host organization. For those individuals entering data into the NCOA database, please send your signed non-disclosure agreement to Maureen Lally at DSHS/ALTSA/HCA, lallym@dshs.wa.gov.

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Participant Information Survey

Participant information survey files in multiple languages.

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