WW Workplan Template IPR Year 2 FINAL 01.22.15.pdf

WISEWOMAN Progress Report Year 2 Page 1 of 81

Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN): Grantee Progress Report (Year 2) July 1, 2014 – December 31, 2014

Awardee:

Awardee Number:

Work Plan Instructions:

Please use the template to report on progress for Year 2 reporting period, July – December, 2014. Information requested can be entered into the text box for each program component. Please be concise but provide context and information that fully describes your successes, challenges, evaluation results/progress to date and progress toward meeting performance measures.

Work Plan

• Provide a succinct description of your accomplishments and progress made in meeting each of the current budget period activities and objectives. If objectives are not on target to be completed by end of budget year, you should provide the reason(s) for delay and identify strategies to be implemented to achieve the objectives.

• Successes: Information can be entered in progress notes.

o Awardees must report progress made to date toward completing activities outlined in the work plan.

o Awardees must describe any additional successes (e.g., identified through evaluation results or lessons learned) achieved in the reporting period.

o Awardees must describe success stories

• Challenges – Information can be entered in progress notes.

o Awardees must describe any challenges that might affect their ability to achieve annual and project-period outcomes, conduct performance measures, or complete the activities in the work plan.

WISEWOMAN Progress Report Year 2 Page 2 of 81 o Awardees must describe any additional challenges (e.g., identified through evaluation results or lessons learned) encountered in the reporting period.

o Awardees must describe how CDC could help them overcome challenges to achieving annual and project-period outcomes and performance measures, and completing activities outlined in the work plan.

Evaluation Results– report evaluation progress or results for the work completed (including any data about the effects of the program).

Performance Measures: Please complete the table at the end of this template for current year progress, Year 2, July 1, 2014 through December 31, 2014. Under progress, please indicate if the performance measure is on target for the current year. Under comments, please briefly describe elements that contributed to meeting the performance measure, challenges to meeting it and strategies to facilitate meeting it.

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WISEWOMAN Progress Report Year 2 Page 3 of 81

Program Management

Domain Progress Notes (optional):

Goals

Goal 1:

Goal 2:

Goal 3:

Annual Objective 0.1: Ensure that the staff number is adequate and appropriately skilled to conduct successful program implementation.

Person Responsible:

Objective Monitoring Plan – Describe below the plan for monitoring the progress of the objective.

How will the objective be monitored?:

Data Source:

Frequency of Monitoring: Select Frequency

Objective Progress:

Objective Status: Select Status

Progress Notes:

Planned Activities Timeframe Activity 0.1.1: Start: Select Date

End: Select Date

WISEWOMAN Progress Report Year 2 Page 4 of 81

Activity 0.1.2: Start: Select Date

End: Select Date Activity 0.1.3: Start: Select Date

End: Select Date Activity 0.1.4: Start: Select Date

End: Select Date Activity 0.1.5: Start: Select Date

End: Select Date Activity 0.1.6: Start: Select Date

End: Select Date Activity 0.1.7: Start: Select Date

End: Select Date Activity 0.1.8: Start: Select Date

End: Select Date Activity 0.1.9: Start: Select Date

End: Select Date Activity 0.1.10: Start: Select Date

Annual Objective 0.2: 100% of internal WISEWOMAN personnel develop and maintain skills needed for successful program implementation through participation in professional development opportunities.

Person Responsible:

Objective Monitoring Plan – Describe below the plan for monitoring the progress of the objective.

How will the objective be monitored?:

Data Source:

Frequency of Monitoring: Select Frequency

WISEWOMAN Progress Report Year 2 Page 5 of 81

Objective Progress:

Activity 0.2.1: Start: Select Date

End: Select Date Activity 0.2.2: Start: Select Date

End: Select Date Activity 0.2.3: Start: Select Date

End: Select Date Activity 0.2.4: Start: Select Date

End: Select Date Activity 0.2.5: Start: Select Date

End: Select Date Activity 0.2.6: Start: Select Date

End: Select Date Activity 0.2.7: Start: Select Date

End: Select Date Activity 0.2.8: Start: Select Date

End: Select Date Activity 0.2.9: Start: Select Date

End: Select Date Activity 0.2.10: Start: Select Date

WISEWOMAN Progress Report Year 2 Page 6 of 81

Annual Objective 0.3: Ensure that WISEWOMAN providers and coaching staff have needed skills for effective program implementation by providing professional development.

Person Responsible:

Objective Monitoring Plan – Describe below the plan for monitoring the progress of the objective.

How will the objective be monitored?:

Data Source:

Frequency of Monitoring: Select Frequency

Planned Activities Timeframe Activity 0.3.1: Start: Select Date

End: Select Date Activity 0.3.2: Start: Select Date

End: Select Date Activity 0.3.3: Start: Select Date

End: Select Date Activity 0.3.4: Start: Select Date

End: Select Date Activity 0.3.5: Start: Select Date

End: Select Date Activity 0.3.6: Start: Select Date

End: Select Date Activity 0.3.6: Start: Select Date

End: Select Date Activity 0.3.7: Start: Select Date

End: Select Date Activity 0.3.8: Start: Select Date

Activity 0.3.9: Start: Select Date

WISEWOMAN Progress Report Year 2 Page 7 of 81

End: Select Date Activity 0.3.10: Start: Select Date

Annual Objective 0.4: Adhere to all fiscal requirements of WISEWOMAN (e.g. 60/40, match, Federal Financial Report, accurate budget).

Person Responsible:

Objective Monitoring Plan – Describe below the plan for monitoring the progress of the objective.

How will the objective be monitored?:

Data Source:

Frequency of Monitoring: Select Frequency

Objective Progress:

Activity 0.4.1: Start: Select Date

End: Select Date Activity 0.4.2: Start: Select Date

End: Select Date Activity 0.4.3: Start: Select Date

End: Select Date Activity 0.4.4: Start: Select Date

Activity 0.4.5: Start: Select Date

WISEWOMAN Progress Report Year 2 Page 8 of 81

End: Select Date Activity 0.4.6: Start: Select Date

End: Select Date Activity 0.4.6: Start: Select Date

End: Select Date Activity 0.4.7: Start: Select Date

End: Select Date Activity 0.4.8: Start: Select Date

End: Select Date Activity 0.4.9: Start: Select Date

End: Select Date Activity 0.4.10: Start: Select Date

Annual Objective 0.5: 100% of contracts are executed in a timely manner and monitored.

Objective Monitoring Plan – Describe below the plan for monitoring the progress of the objective.

How will the objective be monitored?:

Data Source:

Frequency of Monitoring: Select Frequency

Objective Progress:

WISEWOMAN Progress Report Year 2 Page 9 of 81

Activity 0.5.1: Start: Select Date

End: Select Date Activity 0.5.2: Start: Select Date

End: Select Date Activity 0.5.3: Start: Select Date

End: Select Date Activity 0.5.4: Start: Select Date

End: Select Date Activity 0.5.5: Start: Select Date

End: Select Date Activity 0.5.6: Start: Select Date

End: Select Date Activity 0.5.6: Start: Select Date

End: Select Date Activity 0.5.7: Start: Select Date

End: Select Date Activity 0.5.8: Start: Select Date

End: Select Date Activity 0.5.9: Start: Select Date

End: Select Date Activity 0.5.10: Start: Select Date

Annual Objective 0.6: Conduct quality assurance on all WISEWOMAN activities and revise processes as indicated.

Objective Monitoring Plan – Describe below the plan for monitoring the progress of the objective.

How will the objective be monitored?:

WISEWOMAN Progress Report Year 2 Page 10 of 81

Objective Progress:

Activity 0.6.1: Start: Select Date

End: Select Date Activity 0.6.2: Start: Select Date

End: Select Date Activity 0.6.3: Start: Select Date

End: Select Date Activity 0.6.4: Start: Select Date

End: Select Date Activity 0.6.5: Start: Select Date

End: Select Date Activity 0.6.6: Start: Select Date

End: Select Date Activity 0.6.6: Start: Select Date

End: Select Date Activity 0.6.7: Start: Select Date

End: Select Date Activity 0.6.8: Start: Select Date

End: Select Date Activity 0.6.9: Start: Select Date

Activity 0.6.10: Start: Select Date

WISEWOMAN Progress Report Year 2 Page 11 of 81

Annual Objective 0.7:

Objective Monitoring Plan – Describe below the plan for monitoring the progress of the objective.

How will the objective be monitored?:

Data Source:

Frequency of Monitoring: Select Frequency

Objective Progress:

Activity 0.7.1: Start: Select Date

End: Select Date Activity 0.7.2: Start: Select Date

End: Select Date Activity 0.7.3: Start: Select Date

End: Select Date Activity 0.7.4: Start: Select Date

End: Select Date Activity 0.7.5: Start: Select Date

Activity 0.7.6: Start: Select Date

WISEWOMAN Progress Report Year 2 Page 12 of 81

End: Select Date Activity 0.7.6: Start: Select Date

End: Select Date Activity 0.7.7: Start: Select Date

End: Select Date Activity 0.7.8: Start: Select Date

End: Select Date Activity 0.7.9: Start: Select Date

End: Select Date Activity 0.7.10: Start: Select Date

WISEWOMAN Progress Report Year 2 Page 13 of 81

Domain 1: Epidemiology and Surveillance: Gather, analyze, and disseminate data and information and conduct evaluation to inform, prioritize, deliver, and monitor programs and population health.

Goal 2:

Goal 3:

Annual Objective 1.1: Maintain a data collection system that collects all required MDEs.

Person Responsible:

Objective Monitoring Plan – Describe below the plan for monitoring the progress of the objective.

How will the objective be monitored?:

Data Source:

Frequency of Monitoring: Select Frequency

Objective Progress:

WISEWOMAN Progress Report Year 2 Page 14 of 81

Planned Activities Select all collaborating partners for each activity Timeframe Activity 1.1.1: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 1.1.2: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 1.1.3: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 1.1.4: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 1.1.5: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 1.1.6: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

Activity 1.1.7: Partner 1: Select One Start: Select Date

WISEWOMAN Progress Report Year 2 Page 15 of 81

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

End: Select Date

Activity 1.1.8: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 1.1.9: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 1.1.10: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

Annual Objective 1.2: Submit minimum data element files on schedule and with no more than a 5% error rate. [PERFORMANCE MEASURE]

Objective Monitoring Plan – Describe below the plan for monitoring the progress of the objective.

How will the objective be monitored?:

Data Source:

WISEWOMAN Progress Report Year 2 Page 16 of 81

Activity 1.2.1: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 1.2.2: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 1.2.3: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 1.2.4: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 1.2.5: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

Activity 1.2.6: Partner 1: Select One Start: Select Date

WISEWOMAN Progress Report Year 2 Page 17 of 81

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

End: Select Date

Activity 1.2.7: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 1.2.8: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 1.2.9: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 1.2.10: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Annual Objective 1.3: Use data reports for programmatic quality improvement.

Objective Monitoring Plan – Describe below the plan for monitoring the progress of the objective.

WISEWOMAN Progress Report Year 2 Page 18 of 81

Frequency of Monitoring: Select Frequency

Objective Progress:

Activity 1.3.1: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 1.3.2: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 1.3.3: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 1.3.4: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 1.3.5: Partner 1: Select One Start: Select Date

WISEWOMAN Progress Report Year 2 Page 19 of 81

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Activity 1.3.6: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 1.3.7: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 1.3.8: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 1.3.9: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 1.3.10: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

WISEWOMAN Progress Report Year 2 Page 20 of 81

Annual Objective 1.4: Use existing surveillance data to identify cardiovascular risk factors and needs of population to inform program planning.

Person Responsible:

Objective Monitoring Plan – Describe below the plan for monitoring the progress of the objective.

How will the objective be monitored?:

Data Source:

Frequency of Monitoring: Select Frequency

Objective Progress:

Activity 1.4.1: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 1.4.2: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 1.4.3: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

Activity 1.4.4: Partner 1: Select One Start: Select Date

WISEWOMAN Progress Report Year 2 Page 21 of 81

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

End: Select Date

Activity 1.4.5: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 1.4.6: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 1.4.7: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 1.4.8: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 1.4.9: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 1.4.10: Partner 1: Select One Start: Select Date

WISEWOMAN Progress Report Year 2 Page 22 of 81

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Annual Objective 1.5:

Objective Monitoring Plan – Describe below the plan for monitoring the progress of the objective.

How will the objective be monitored?:

Data Source:

Frequency of Monitoring: Select Frequency

Objective Progress:

Activity 1.5.1: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 1.5.2: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

WISEWOMAN Progress Report Year 2 Page 23 of 81

Activity 1.5.3: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 1.5.4: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 1.5.5: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 1.5.6: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 1.5.7: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 1.5.8: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

Activity 1.5.9: Partner 1: Select One Start: Select Date

WISEWOMAN Progress Report Year 2 Page 24 of 81

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

End: Select Date

Activity 1.5.10: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

WISEWOMAN Progress Report Year 2 Page 25 of 81

Domain 2: Environmental Approaches: Promote health and support and reinforce healthful behaviors (statewide in schools, worksites, and communities).

Goal 2:

Goal 3:

Annual Objective 2.1: Use community scans findings to support improvements in cardiovascular risk of participants.

Person Responsible:

Objective Monitoring Plan – Describe below the plan for monitoring the progress of the objective.

How will the objective be monitored?:

Data Source:

Frequency of Monitoring: Select Frequency

Objective Progress:

Activity 2.1.1: Partner 1: Select One Start: Select Date

WISEWOMAN Progress Report Year 2 Page 26 of 81

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

End: Select Date

Activity 2.1.2: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 2.1.3: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 2.1.4: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 2.1.5: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 2.1.6: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 2.1.7: Partner 1: Select One

Partner 2: Select One

WISEWOMAN Progress Report Year 2 Page 27 of 81

Partner 3: Select One

Other (if applicable):

Activity 2.1.8: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 2.1.9: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 2.1.10: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Annual Objective 2.2: Increase options to reinforce healthful behaviors in the community by partnering with at least 2 organizations.

[PERFORMANCE MEASURE]

Person Responsible:

Objective Monitoring Plan – Describe below the plan for monitoring the progress of the objective.

How will the objective be monitored?:

Data Source:

Frequency of Monitoring: Select Frequency

WISEWOMAN Progress Report Year 2 Page 28 of 81

Activity 2.2.1: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 2.2.2: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 2.2.3: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 2.2.4: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 2.2.5: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 2.2.6: Partner 1: Select One

Partner 2: Select One

WISEWOMAN Progress Report Year 2 Page 29 of 81

Partner 3: Select One

Other (if applicable):

Activity 2.2.7: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 2.2.8: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 2.2.9: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 2.2.10: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Annual Objective 2.3:

Objective Monitoring Plan – Describe below the plan for monitoring the progress of the objective.

How will the objective be monitored?:

WISEWOMAN Progress Report Year 2 Page 30 of 81

Activity 2.3.1: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 2.3.2: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 2.3.3: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 2.3.4: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 2.3.5: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

WISEWOMAN Progress Report Year 2 Page 31 of 81

Other (if applicable):

Activity 2.3.6: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 2.3.7: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 2.3.8: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 2.3.9: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 2.3.10: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

WISEWOMAN Progress Report Year 2 Page 32 of 81

Domain 3: Health Systems: Improve the effective delivery and use of clinical and other preventive services in order to prevent disease, detect diseases early, and reduce or eliminate risk factors and mitigate or manage complications.

Goal 2:

Goal 3:

Annual Objective 3.1: Improve WISEWOMAN providers’ use of systems to optimize control of hypertension.

Person Responsible:

Objective Monitoring Plan – Describe below the plan for monitoring the progress of the objective.

How will the objective be monitored?:

Data Source:

Frequency of Monitoring: Select Frequency

Objective Progress:

WISEWOMAN Progress Report Year 2 Page 33 of 81

Activity 3.1.1: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.1.2: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.1.3: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.1.4: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.1.5: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.1.6: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

Activity 3.1.7: Partner 1: Select One Start: Select Date

WISEWOMAN Progress Report Year 2 Page 34 of 81

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

End: Select Date

Activity 3.1.8: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.1.9: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.1.10: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Annual Objective 3.2: Meet or exceed 95% of CDC approved screening goal. [PERFORMANCE MEASURE]

Target # to be Screened:

Person Responsible:

Objective Monitoring Plan – Describe below the plan for monitoring the progress of the objective.

How will the objective be monitored?:

Data Source:

WISEWOMAN Progress Report Year 2 Page 35 of 81

Activity 3.2.1: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.2.2: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.2.3: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.2.4: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.2.5: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

Activity 3.2.6: Partner 1: Select One Start: Select Date

WISEWOMAN Progress Report Year 2 Page 36 of 81

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

End: Select Date

Activity 3.2.7: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.2.8: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.2.9: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.2.10: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Annual Objective 3.3: Follow-up with 100% of women with abnormal blood pressure values. [PERFORMANCE MEASURE]

Objective Monitoring Plan – Describe below the plan for monitoring the progress of the objective.

WISEWOMAN Progress Report Year 2 Page 37 of 81

Objective Progress:

Activity 3.3.1: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.3.2: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.3.3: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.3.4: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.3.5: Partner 1: Select One

Partner 2: Select One

WISEWOMAN Progress Report Year 2 Page 38 of 81

Partner 3: Select One

Other (if applicable):

Activity 3.3.6: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.3.7: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date End: Select Date

Activity 3.3.8: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date End: Select Date

Activity 3.3.9: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date End: Select Date

Activity 3.3.10: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Annual Objective 3.4: Deliver quality risk reduction counseling to 100% of women screened. [PERFORMANCE MEASURE]

WISEWOMAN Progress Report Year 2 Page 39 of 81

Objective Monitoring Plan – Describe below the plan for monitoring the progress of the objective.

How will the objective be monitored?:

Data Source:

Frequency of Monitoring: Select Frequency

Objective Progress:

Activity 3.4.1: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.4.2: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.4.3: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.4.4: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

WISEWOMAN Progress Report Year 2 Page 40 of 81

Other (if applicable):

Activity 3.4.5: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.4.6: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.4.7: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date End: Select Date

Activity 3.4.8: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date End: Select Date

Activity 3.4.9: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date End: Select Date

Activity 3.4.10: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

WISEWOMAN Progress Report Year 2 Page 41 of 81

Annual Objective 3.5: Assure systems in place for medication access, support and follow-up for WISEWOMAN participants.

Objective Monitoring Plan – Describe below the plan for monitoring the progress of the objective.

How will the objective be monitored?:

Data Source:

Frequency of Monitoring: Select Frequency

Objective Progress:

Activity 3.5.1: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.5.2: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.5.3: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

WISEWOMAN Progress Report Year 2 Page 42 of 81

Activity 3.5.4: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.5.5: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.5.6: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.5.7: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date End: Select Date

Activity 3.5.8: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date End: Select Date

Activity 3.5.9: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date End: Select Date

Activity 3.5.10: Partner 1: Select One Start: Select Date

WISEWOMAN Progress Report Year 2 Page 43 of 81

Partner 2: Select One

Annual Objective 3.6: Assure all participants are linked to tailored healthy behavior support options (e.g. LSP/health coaching/tobacco cessation).

Person Responsible:

Objective Monitoring Plan – Describe below the plan for monitoring the progress of the objective.

How will the objective be monitored?:

Data Source:

Frequency of Monitoring: Select Frequency

Objective Progress:

Activity 3.6.1: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.6.2: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

WISEWOMAN Progress Report Year 2 Page 44 of 81

Other (if applicable):

Activity 3.6.3: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.6.4: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.6.5: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.6.6: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.6.7: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date End: Select Date

Activity 3.6.8: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

WISEWOMAN Progress Report Year 2 Page 45 of 81

Activity 3.6.9: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date End: Select Date

Activity 3.6.10: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Annual Objective 3.7:

Objective Monitoring Plan – Describe below the plan for monitoring the progress of the objective.

How will the objective be monitored?:

Data Source:

Frequency of Monitoring: Select Frequency

Objective Progress:

Activity 3.7.1: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

WISEWOMAN Progress Report Year 2 Page 46 of 81

Other (if applicable):

Activity 3.7.2: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.7.3: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.7.4: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.7.5: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.7.6: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.7.7: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

WISEWOMAN Progress Report Year 2 Page 47 of 81

Activity 3.7.8: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date End: Select Date

Activity 3.7.9: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date End: Select Date

Activity 3.7.10: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Annual Objective 3.8:

Objective Monitoring Plan – Describe below the plan for monitoring the progress of the objective.

How will the objective be monitored?:

Data Source:

Frequency of Monitoring: Select Frequency

Objective Progress:

WISEWOMAN Progress Report Year 2 Page 48 of 81

Activity 3.8.1: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.8.2: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.8.3: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.8.4: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.8.5: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.8.6: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 3.8.7: Partner 1: Select One Start: Select Date

WISEWOMAN Progress Report Year 2 Page 49 of 81

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Activity 3.8.8: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date End: Select Date

Activity 3.8.9: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date End: Select Date

Activity 3.8.10: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

WISEWOMAN Progress Report Year 2 Page 50 of 81

Domain 4: Community-Clinical Linkages: Ensure that communities support and clinics refer patients to programs that improve management of chronic conditions. Such interventions ensure those with or at high risk for chronic diseases have access to quality community resources to best manage their conditions or disease risk.

Goal 2:

Goal 3:

Annual Objective 4.1: Assure approved LSP/coaching programs are implemented with fidelity.

Person Responsible:

Objective Monitoring Plan – Describe below the plan for monitoring the progress of the objective.

How will the objective be monitored?:

Data Source:

Frequency of Monitoring: Select Frequency

Objective Progress:

WISEWOMAN Progress Report Year 2 Page 51 of 81

Activity 4.1.1: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 4.1.2: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 4.1.3: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 4.1.4: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 4.1.5: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 4.1.6: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 4.1.7: Partner 1: Select One Start: Select Date

WISEWOMAN Progress Report Year 2 Page 52 of 81

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Activity 4.1.8: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date End: Select Date

Activity 4.1.9: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date End: Select Date

Activity 4.1.10: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Annual Objective 4.2: Assure all participants have access to at least one healthy behavior support option.

Objective Monitoring Plan – Describe below the plan for monitoring the progress of the objective.

How will the objective be monitored?:

Data Source:

Frequency of Monitoring: Select Frequency

WISEWOMAN Progress Report Year 2 Page 53 of 81

Activity 4.2.1: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 4.2.2: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 4.2.3: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 4.2.4: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 4.2.5: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 4.2.6: Partner 1: Select One

Partner 2: Select One

WISEWOMAN Progress Report Year 2 Page 54 of 81

Partner 3: Select One

Other (if applicable):

Activity 4.2.7: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date End: Select Date

Activity 4.2.8: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date End: Select Date

Activity 4.2.9: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date End: Select Date

Activity 4.2.10: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Annual Objective 4.3: Assure 80% of WISEWOMAN participants referred to a lifestyle program or health coaching attend at least one session.

[PERFORMANCE MEASURE]

Person Responsible:

Objective Monitoring Plan – Describe below the plan for monitoring the progress of the objective.

WISEWOMAN Progress Report Year 2 Page 55 of 81

Objective Progress:

Activity 4.3.1: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 4.3.2: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 4.3.3: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 4.3.4: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 4.3.5: Partner 1: Select One

Partner 2: Select One

WISEWOMAN Progress Report Year 2 Page 56 of 81

Partner 3: Select One

Other (if applicable):

Activity 4.3.6: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 4.3.7: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date End: Select Date

Activity 4.3.8: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date End: Select Date

Activity 4.3.9: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date End: Select Date

Activity 4.3.10: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

WISEWOMAN Progress Report Year 2 Page 57 of 81

Annual Objective 4.4: Assure 60% of WISEWOMAN participants who participate in a lifestyle program or health coaching complete the program (as defined by approved template). [PERFORMANCE MEASURE]

Person Responsible:

Objective Monitoring Plan – Describe below the plan for monitoring the progress of the objective.

How will the objective be monitored?:

Data Source:

Frequency of Monitoring: Select Frequency

Objective Progress:

Activity 4.4.1: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 4.4.2: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 4.4.3: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

WISEWOMAN Progress Report Year 2 Page 58 of 81

Activity 4.4.4: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 4.4.5: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 4.4.6: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 4.4.7: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date End: Select Date

Activity 4.4.8: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date End: Select Date

Activity 4.4.9: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date End: Select Date

Activity 4.4.10: Partner 1: Select One Start: Select Date

WISEWOMAN Progress Report Year 2 Page 59 of 81

Partner 2: Select One

Annual Objective 4.5: Assure tobacco cessation referral systems to state quit lines and/or community resources are in place and referral outcomes are documented and can be conveyed to CDC and WISEWOMAN providers.

Person Responsible:

Objective Monitoring Plan – Describe below the plan for monitoring the progress of the objective.

How will the objective be monitored?:

Data Source:

Frequency of Monitoring: Select Frequency

Objective Progress:

Activity 4.5.1: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 4.5.2: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

WISEWOMAN Progress Report Year 2 Page 60 of 81

Other (if applicable):

Activity 4.5.3: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 4.5.4: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 4.5.5: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 4.5.6: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 4.5.7: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date End: Select Date

Activity 4.5.8: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

WISEWOMAN Progress Report Year 2 Page 61 of 81

Activity 4.5.9: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date End: Select Date

Activity 4.5.10: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Annual Objective 4.6: Assess uptake of healthy behavior support options to assure WISEWOMAN participants’ needs are met.

Objective Monitoring Plan – Describe below the plan for monitoring the progress of the objective.

How will the objective be monitored?:

Data Source:

Frequency of Monitoring: Select Frequency

Objective Progress:

Activity 4.6.1: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

WISEWOMAN Progress Report Year 2 Page 62 of 81

Other (if applicable):

Activity 4.6.2: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 4.6.3: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 4.6.4: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 4.6.5: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 4.6.6: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 4.6.7: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

WISEWOMAN Progress Report Year 2 Page 63 of 81

Activity 4.6.8: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date End: Select Date

Activity 4.6.9: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date End: Select Date

Activity 4.6.10: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Annual Objective 4.7:

Objective Monitoring Plan – Describe below the plan for monitoring the progress of the objective.

How will the objective be monitored?:

Data Source:

Frequency of Monitoring: Select Frequency

Objective Progress:

WISEWOMAN Progress Report Year 2 Page 64 of 81

Activity 4.7.1: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 4.7.2: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 4.7.3: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 4.7.4: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 4.7.5: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 4.7.6: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 4.7.7: Partner 1: Select One Start: Select Date

WISEWOMAN Progress Report Year 2 Page 65 of 81

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Activity 4.7.8: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date End: Select Date

Activity 4.7.9: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date End: Select Date

Activity 4.7.10: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Annual Objective 4.8:

Objective Monitoring Plan – Describe below the plan for monitoring the progress of the objective.

How will the objective be monitored?:

Data Source:

Frequency of Monitoring: Select Frequency

WISEWOMAN Progress Report Year 2 Page 66 of 81

Activity 4.8.1: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 4.8.2: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 4.8.3: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if applicable):

Start: Select Date

End: Select Date

Activity 4.8.4: Partner 1: Select One

Partner 2: Select One

Partner 3: Select One

Other (if…