SPECIAL DIABETES PROGRAM FOR INDIANS Competitive Grant Program Special Diabetes Program for Indians Competitive Grant Program SPECIAL DIABETES PROGRAM FOR INDIANS Competitive Grant Program Orientation for New Staff Day 2 Data Requirements - Continued

SPECIAL DIABETES PROGRAM FOR INDIANS Competitive Grant Program Karen Wilde Rogers DP Data Coordinator CGP Coordinating Center Jeanne M. Amos HH Data Coordinator CGP Coordinating Center

SPECIAL DIABETES PROGRAM FOR INDIANS Competitive Grant Program Steps in Forms Collection Overview (Operations Manual pg. 32)

SPECIAL DIABETES PROGRAM FOR INDIANS Competitive Grant Program Review of Day 1 Data Requirements Recruitment/Screening (Step 1) Intensive Activity – Baseline (Step 2)  Timelines Intensive Activity - DPP Curriculum/HH Case Management (Step 3)

SPECIAL DIABETES PROGRAM FOR INDIANS Competitive Grant Program Day 2 Data Requirements Safety and Confidentiality Forms Participant Level Follow-up Forms (Step 4, DP only) Participant Level Annual Forms (Step 5) Grantee Level Annual Forms (on-going, various steps) Grantee Level Annual Questionnaires (Step 6)

SPECIAL DIABETES PROGRAM FOR INDIANS Competitive Grant Program Safety & Confidentiality Forms Serious Adverse Event (SAE) Incident Report Form (IRF) Accounting of Disclosures Form

SPECIAL DIABETES PROGRAM FOR INDIANS Competitive Grant Program Forms List Forms Identification Scheme (Appendix J) Forms List

SPECIAL DIABETES PROGRAM FOR INDIANS Competitive Grant Program Participant Level Follow-up Forms (Step 4, DP only) Participant Follow-up Assessment of Core Elements (FACE – F1)Participant Follow-up Assessment of Core Elements Participant Follow-up Questionnaire (PFQ – F2)Participant Follow-up Questionnaire PFQ Family Follow-up Questionnaire (FFQ – F3)Family Follow-up Questionnaire FFQ

SPECIAL DIABETES PROGRAM FOR INDIANS Competitive Grant Program Participant Level Annual Forms (Step 5) Participant Annual Assessment of Core Elements DPDP / HH (AACE – A1)HH Participant Annual Questionnaire DP / HH (PAQ – A2)DPHH  Will be mailed to grantees  This is a scannable form Family Annual Questionnaire DP / HH (FAQ – A3)DPHH  Will be mailed to grantees  This is a scannable form

SPECIAL DIABETES PROGRAM FOR INDIANS Competitive Grant Program DP Only – Midyear FBG An FGB is required between Annual Assessments. A 1-page form will be provided for the 18- month and 30-month FBG.

SPECIAL DIABETES PROGRAM FOR INDIANS Competitive Grant Program Grantee Level Annual Forms (On-going) Recruitment Team Meetings Form (R3) (Step 1) DP Team Meetings Form (I1 - DP) (Step 3) OR Case Mgmt Team Meetings Form (I1 - HH) (Step 3) Recruitment Activities Annual Report (AD1) (Step 1) Retention Activities Annual Report (AD2) Retention Activities Annual Report After-Core Activities Annual Report (AD6 – DP only) After-Core Activities Annual Report

SPECIAL DIABETES PROGRAM FOR INDIANS Competitive Grant Program Grantee Level Annual Questionnaires (Step 6) (For reference only) Provider Annual Questionnaire (AD3) Organization Annual Questionnaire (AD4) Community Annual Questionnaire (AD5)  Scannable forms  Mailed out in November

SPECIAL DIABETES PROGRAM FOR INDIANS Competitive Grant Program Karen Wilde Rogers DP Data Coordinator CGP Coordinating Center Jeanne M. Amos HH Data Coordinator CGP Coordinating Center