Use of Action Plan and Step Tracking Form...The action plan is to modify or replace an existing...
Transcript of Use of Action Plan and Step Tracking Form...The action plan is to modify or replace an existing...
Use of Action Plan and Step Tracking Form; Sample Medical Entries – August 2014
Use of Action Plan and Step Tracking Form; Sample Medical Record Entries
Action Plan:
The action plan form is a primary tool used in the AHF program to assist the child and family in establishing
a healthy behavior/lifestyle. The action plan form is explained in the first session where the child and
parent choose from a list of suggested lifestyle activities to work on.
The action plan is to modify or replace an existing unhealthy behavior. The plan should be specific, realistic
and measurable.
Example of an action plan:
Current Practice: The child drinks soda/sweetened drink for dinner every day
Suggested Action Plan: Reduce soda to 3x a week. Drink water with dinner meal instead. See sample
below‐
Use of Action Plan and Step Tracking Form; Sample Medical Entries – August 2014
Step Tracking Form:
The step tracking form is another tool used in the AHF program to encourage and track daily physical
activity. As shown on the form below which is for child and parent to complete (1 side for child and other
side for parent), the goal is 10,000 steps per day. The child and parent record their steps daily and bring
the tracking form at every session for the AHF staff to add up the total number of steps. The child with the
highest number of steps and with weight loss or weight maintained gets a prize. See sample below‐
Use of Action Plan and Step Tracking Form; Sample Medical Entries – August 2014
Sample Medical Entries
Outpatient Notes
The Outpatient Notes form was the recommended form used prior to the conversion of the Contra Costa
Health Services to the electronic medical records. The recommended information to include when
completing a medical entry for each patient at each session is featured.
Use of Action Plan and Step Tracking Form; Sample Medical Entries – August 2014
Samples of Completed Electronic Medical Record Entries for:
Active & Healthy Families Group Appointment‐ Session 1
Use of Action Plan and Step Tracking Form; Sample Medical Entries – August 2014
Active & Healthy Families Group Appointments‐ Session 2