Standard 9 – Participant Progress

The provider(s) of DSMES services will monitor and communicate whether participants are achieving their personal diabetes self-management goals and other outcome(s) to evaluate the effectiveness of the educational intervention(s), using appropriate measurement techniques.

Tools to Satisfy Standard 9


ADCES Tool to Satisfy Standard 9 pdf icon[PDF – 316 KB]external icon:
This tool outlines the components needed for your application for Standard 9.

Sample Personal Self-Management Planpdf iconexternal icon
This is a sample template of a personal self-management plan.

Sample Goal Formpdf iconexternal icon
This is a sample form to set and document progress on personal self-management goals.

Sample Letter pdf iconexternal icon
This is a sample letter from a DSMES service to a referring health care provider reporting the participant’s outcomes.

Letter Templatepdf iconexternal icon
This letter template is an example of how to communicate feedback on participant DSMES outcomes to the referring healthcare provider.


Behavior and Other Participant Outcomes pdf icon[PDF – 274 KB]external icon:
This is a sample template to record behavior and other participant outcomes.

Sample Participant Behavioral Goals pdf icon[PDF – 63 KB]external icon:
This form can be used to help set and document progress toward a patient’s personal health goals.

Communication to Healthcare Provider pdf icon[PDF – 311 KB]external icon:
This link provides an example of how to communicate participant outcomes to the referring provider or other healthcare providers outside of the DSMES service.

Page last reviewed: February 3, 2021