Lifestyle Change Program Referral Sample

Use this sample as a guide for creating a form to refer eligible patients to a National DPP lifestyle change program. By completing a referral form, patients give permission for health care providers to use and disclose certain protected health information. Work with your appropriate internal departments (e.g., legal, risk, IT) to create a referral process for your organization that is compliant with applicable laws.
Clinical Process
Prediabetes

PDF  •  English  •  Last updated: 05/05/2025

Bidirectional Feedback Loop

Utilize this document to learn the process for how information flows between the clinical care team and the National DPP lifestyle change program provider.
Clinical Process
Clinical Team Education
Prediabetes

PDF  •  English  •  Last updated: 05/05/2025

Optimize Your Electronic Health Record to Prevent Type 2 Diabetes

This document provides guidance and suggestions on how to use your electronic health record (EHR) to identify and manage patients at risk for type 2 diabetes.
Clinical Process
Clinical Team Education
Prediabetes

PDF  •  English  •  Last updated: 05/05/2025

BP Measurement Skills Assessment

Checklist of proper positioning and procedures for in-office BP measurement for training care team members on blood pressure measurement protocols.
Clinical Process
Clinical Team Education
Hypertension

PDF  •  English  •  Last updated: 03/05/2025

Clinical Inertia Assessment

Measure how often clinical inertia occurs and identify contributing factors in your practice.
Clinical Process
Clinical Team Education
Hypertension

PDF  •  English  •  Last updated: 03/05/2025

SMBP Device Calibration Test

Outlines steps care team can take to calibrate a patient's SMBP device.
Clinical Team Education
Clinical Process
Hypertension

PDF  •  English  •  Last updated: 03/05/2025

SMBP Loaner Device Agreement

Agreement between the clinic and patient when a loaner device is used.
Clinical Process
Hypertension

PDF  •  English, Arabic, Chinese, French, Haitian-Creole, Hindi, Hmong, Korean, Polish, Portuguese, Russian, Somali, Spanish, Tagalog, Ukranian, Vietnamese, Albanian, Bosnian  •  Last updated: 03/10/2025

SMBP Patient Training Checklist - In Person

Training tool for clinicians to ensure patients who are using a device understand proper SMBP technique and processes.
Clinical Process
Clinical Team Education
Hypertension

PDF  •  English  •  Last updated: 03/05/2025

SMBP Patient Training Checklist - Virtual

Ensure all necessary information and steps are covered when virtually training patients on SMBP
Clinical Team Education
Clinical Process
Hypertension

PDF  •  English  •  Last updated: 03/05/2025

BP Measurement Competency Assessment

A checklist to assess your ability to accurately obtain initial and confirmatory blood pressure measurements.
Clinical Process
Clinical Team Education
Hypertension

PDF  •  English  •  Last updated: 03/05/2025