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Downloadable Resources for CHAP Coordinators
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Click on the subject heading for a list of related resources available to CHAP Coordinators. Resources are in either Microsoft Office applications format (.doc, .ppt) or in Adobe PDF format (.pdf).
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New/Helpful Resources |
- Appendix 5.5 Family Physician Recruitment Guide (NEW 2008) (.doc)
Guide used by Local CHAP Coordinator to recruit family physician participation in the program when visiting local practices. - Appendix 5.9 Family Physician Frequently Asked Questions (UPDATED 2008) (.doc)
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Appendix 5.11 Invitation Letter from FP CHAP+AP Champion to Local FPs (.doc)
Template letter from the FP Champion requesting the participation of local FPs in CHAP+AP -
Appendix 8.4.1 Instructions for Completing the Risk Profile Recording Form (NEW 2008) (.doc)
Specific, step-by-step instructions for completing the Risk Profile Recording Form - Appendix 8.4.2 Common Risk Profile Recording Form Errors (NEW 2008) (.doc)
- Appendix 10.7 TIPS on obtaining educational pamphlets and resources for distribution at sessions (UPDATED 2008) (.doc)
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Appendix 8.12 Mentorship Discussion Form (.doc)
Form to capture session activities, and changes in participant behaviours and outcomes over time. To be mailed (Canada Post) to CHAP Central on a regular basis (schedule TBD)
CHAP Letters of Support |
- Canadian Association of Chain Drug Stores (doc)
- Dell Pharmacies (pdf)
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Heart and Stroke pg1 (pdf)
Heart and Stroke pg2 (pdf) -
Kidney Foundation of Ontario pg1 (pdf)
Kidney Foundation of Ontario pg2 (pdf) - Ontario College of Family Physicians (pdf)
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Ministry of Health pg1 (pdf)
Ministry of Health pg2 (pdf) - Pfizer Canada Inc (pdf)
- Pharmasave (pdf)
- VSM Med Tech (pdf)
Implementation Guide |
Implementation Guide Appendices |
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1.0 Job Descriptions
Each job description lists the key responsibilities and qualifications for the specified position. -
2.0 Communications Plan
An overview of the plan to publicize CHAP in the community, including: a summary of the issues, Program description, Program goals, communications goals, target audience, key messages, channels for communication, deliverables, print materials and press releases.-
Appendix 2.0 Communications Plan (.doc)
An overview of the plan to publicize CHAP in the community, including: a summary of the issues, Program description, Program goals, communications goals, target audience, key messages, channels for communication, deliverables, print materials and press releases. -
Appendix 2.1 Media Releases (three examples) (.doc)
Three sample press releases: 1) to introduce the coming Program; 2) to provide specifics about the Program as it is launched; 3) to provide a progress report on the Program. -
Appendix 2.2 Poster or Newspaper Advertising - Volunteer Recruitment Poster (.doc)
Sample poster/advertisement to be used to recruit Volunteer Peer Health Educators in the CHAP community. -
Appendix 2.3 Media Release Form (.doc)
Sample poster/advertisement to be used to recruit participants for CHAP pharmacy-based sessions and to increase community awareness of the Program; includes the schedule of CHAP sessions. - Appendix 2.4 CHAP Bilingual Logo (jpg)
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Appendix 2.0 Communications Plan (.doc)
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3.0 One-page CHAP Info Sheet (UPDATED 2008)
A one-page summary of the Program and its goals. -
4.0 CHAP Presentations for Information Sessions (UPDATED 2008)
Two sample Power Point presentations to be used during information sessions with physicians, pharmacists, community organizations, funders, etc. Provides a detailed description of CHAP, including the evolution of the Program and its goals. -
5.0 Physicians (PLEASE SEE APPENDIX 5.5 - UPDATED)
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Appendix 5.1 Physician Letter of Invitation to Information Session (UPDATED 2008) (.doc)
Sample of letter to be sent to family physicians in the CHAP community, inviting them to participate in an Information Session about the Program. Letter is sent by the Local Physician Opinion Leader. Physicians will be asked to indicate their willingness to participate in the Program during the Information Session. -
Appendix 5.2 Family Physician Letter of Understanding (UPDATED 2008) (.doc)
A summary of the CHAP program and a list of the tasks required of participating family physicians. -
Appendix 5.3 Preferred Options Sheet (UPDATED 2008) (.doc)
A form to be completed by participating family physicians to indicate how they choose to have their patients invited to the CHAP pharmacy-based sessions. Options are: 1) personalized mailed invitation; 2) session referral "tickets" distributed opportunistically to patients during an appointment in the practice; and/or 3) community-wide media advertising. -
Appendix 5.4 CHAP Protocol for Blood Pressure Readings (UPDATED 2008) (.doc)
Recommendation Protocol developed in consultation with family physicians and CHAP team members. Used by PHEs, Local CHAP Coordinator, Community Health Nurse and Session Pharmacist to guide reassessment and/or referral of patients, when appropriate, based on their blood pressure readings at the pharmacy session. -
Appendix 5.5 Family Physician Recruitment Guide (.doc)
Guide used by Local CHAP Coordinator to recruit family physician participation in the program when visiting local practices. -
Appendix 5.6 Invitation Letter to Patients (UPDATED 2008) (.doc)
A copy of the personalized letter mailed to patients, on behalf of the family physician, when Option #1 is chosen (see Appendix 5.3 Preferred Options Sheet). -
Appendix 5.7.1 Referral Flyer Template A (UPDATED 2008) (.doc)
Version A of the referral "flyers" to be distributed opportunistically by the physician during patient appointments (Option #2; see Appendix 5.3 Preferred Options Sheet). -
Appendix 5.7.2 Referral Flyer Template B (UPDATED 2008) (.doc)
Version B of the referral "flyers" to be distributed opportunistically by the physician during patient appointments (Option #2; see Appendix 5.3 Preferred Options Sheet). -
Appendix 5.8 Community-wide Advertising for Patients to Attend Sessions (.doc)
Sample of poster/newspaper advertisement used to invite participants to the CHAP sessions. Advertising is for the general public; practice-specific advertisements will not be produced (Option #3; see Appendix 5.3 Preferred Options Sheet). - Appendix 5.9 Family Physician Frequently Asked Questions (UPDATED 2008) (.doc)
- Appendix 5.10 Canada Post Address Requirements (.doc)
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Appendix 5.11 Invitation Letter from FP CHAP+AP Champion to Local FPs (.doc)
Template letter from the FP Champion requesting the participation of local FPs in CHAP+AP
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Appendix 5.1 Physician Letter of Invitation to Information Session (UPDATED 2008) (.doc)
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6.0 Pharmacies (UPDATED 2008)
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Appendix 6.1 Community Pharmacist Information Sheet (.doc)
A summary of the CHAP program and a description of the role, responsibilities and benefits for the participating pharmacist/pharmacy. -
Appendix 6.2 Pharmacist Documentation Form (UPDATED 2008) (.doc)
A copy of the documentation form to be completed by all pharmacists (session and regular) who conduct an assessment of / provide counseling to a CHAP participant. Assessments/counseling can be initiated by the participant, or by the pharmacist when s/he is alerted of a patient with very high or low blood pressure.
- Appendix 6.2.1 Sample of a Completed Pharmacist Documentation Form - Example #1 (.doc)
- Appendix 6.2.2 Sample of a Completed Pharmacist Documentation Form - Example #2 (.doc)
- Appendix 6.2.3 Sample of a Completed Pharmacist Documentation Form - Example #3 (.doc)
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Appendix 6.3 Pharmacist Letter of Understanding (UPDATED 2008) (.doc)
A summary of the CHAP+AP program and a list of the tasks required of participating pharmacists/pharmacies. - Appendix 6.4 CHAP Pharmacist Role (.ppt)
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Appendix 6.1 Community Pharmacist Information Sheet (.doc)
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7.0 Volunteer Peer Health Educators (UPDATED 2008)
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Appendix 7.1 Volunteer Training Overview (.pdf)
Guide to Peer Health Educator Training for Nurses and CHAP Coordinators. -
Appendix 7.2.1 Power Point Presentation - Training Session 1 (UPDATED 2008) (.ppt)
Power Point Presentation for Volunteer Peer Health Educator training on heart disease and stroke risk factors (1 of 4). Topics covered: high blood pressure; the heart and its function; causes of hypertension; risk factors for hypertension, heart disease and stroke; prevention. -
Appendix 7.2.2 Power Point Presentation - Training Session 2 (UPDATED 2008) (.ppt)
Power Point Presentation for Volunteer Peer Health Educator training on CHAP+AP session activities (2 of 4). Topics covered: session setup and procedures; forms; recommendation protocol; interactive session exercise -
Appendix 7.2.3 Power Point Presentation - Training Session 3 BP Action Plan (.ppt)
Power Point Presentation for Volunteer Peer Health Educator training on use of the BP Action Plan with CHAP+AP participants (3 of 4). -
Appendix 7.2.4 Power Point Presentation - Training Session 4 Peer Health Mentors (.ppt)
Power Point Presentation for Volunteer Peer Health Educator training on the Peer Health Mentor Role (4 of 4). Topics include PHM roles and responsibilities; understanding steps to behaviour change and the Stages of Change Model; using the mentorship discussion form -
Appendix 7.3 Volunteer Peer Health Educator Letter of Understanding (UPDATED 2008) (.doc)
Confidentiality agreement signed by all PHEs during training.
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Appendix 7.1 Volunteer Training Overview (.pdf)
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8.0 CHAP Sessions (UPDATED 2008)
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Appendix 8.1 CHAP Pharmacy-based Session Schedule (.doc)
A sample of the session schedule, generated on a monthly basis. This schedule is printed on the back of the Patient Invitation Letter and referral "tickets", and can be distributed where appropriate (e.g., at sessions, in prescription bags, etc.). -
Appendix 8.2 Patient Sign-in Sheet (.doc)
Upon arriving at the session, each participant is asked to sign in on the sheet provided. This procedure will help to ensure that participants are seen on a first come, first serve basis. -
Appendix 8.3 Patient Consent Form (UPDATED 2008) (.doc)
Before taking part in the Program, each participant must read and sign the Patient Consent Form. The form provides a summary of the Program and outlines patient's rights as a voluntary participant in the Program. A copy of the signed form is provided to the participant. -
Appendix 8.4 Risk Profile Recording Form
Volunteers use this form to record the participants' blood pressure readings, and risk factors for heart disease and stroke. The risk profile is only completed on the first visit. A copy of the completed form will be provided to the participant and a copy will be sent to Clinforma. Ensure that the consent section is completed. If the participant refuses consent, or the consent section is not completed, the information contained on the form will not be forwarded to the physician and/or regular pharmacist. Information must be printed and completed CLEARLY in order for the computer to process the information. Samples for each community can be found below.
Site 4 Paris
Site 5 Stratford
Site 7 Thorold
Site 8 Tillsonburg
Site 10 Woodstock
Site 11 Bracebridge
Site 12 Gravenhurst
Site 13 Collingwood
Site 14 Cornwall
Site 15 Elliot Lake
Site 17 Lindsay
Site 19 Pembroke
Site 20 Port Hope
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Appendix 8.4.1 Instructions for Completing the Risk Profile Recording Form (.doc)
Specific, step-by-step instructions for completing the Risk Profile Recording Form -
Appendix 8.4.2 Common Risk Profile Recording Form Errors (.doc)
Examples of common errors made by volunteers -
Appendix 8.5 Name Tags (UPDATED 2008) (.doc)
Name tags to be worn by Volunteer PHEs and Local CHAP Coordinator at all pharmacy sessions. - Appendix 8.6 Sample of Ontario Prevention Clearinghouse Reference Material (.pdf)
- Community Resources for Staying Active
- Community Resources to Alcohol Use
- Community Resources to help Reduce Stress
- Community Resources to Eating Well
- Community Resources for Breaking the Habit
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Appendix 8.7 Get Stroke Smart Wallet Card (.pdf)
A wallet-sized information card, produced by the Heart & Stroke Foundation, outlining the warning signs for a stroke. These cards are to be distributed to all CHAP participants. -
Appendix 8.8 Blood Pressure Basics Information Sheet (UPDATED 2008) (.doc)
A one-page information sheet developed by the CHAP team to describe the importance of having your blood pressure measured on a regular basis. It describes the criteria used to define high blood pressure, with the understanding that a physician is the only one who can make the final diagnosis. -
Appendix 8.9 Clinforma Fax Cover Sheet (.doc)
Fax covers sheet to be used by the Local CHAP Coordinator when s/he faxes the completed Risk Profile Recording Forms to Clinforma's toll-free number. As per the cover sheet, the forms are to be faxed in batches of 10 or less. - Appendix 8.10 BpTRU Quick-Start Guide (.doc)
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Appendix 8.11 Nurse Assessment Form (.doc)
Appendix 8.11 Nurse Assessment Form (.pdf)(UPDATED 2008)
To be completed by the on-call nurse for participants with very high or very low blood pressure -
Appendix 8.12 Mentorship Discussion Form (.doc)
Form to capture session activities, and changes in participant behaviours and outcomes over time. To be mailed (Canada Post) to CHAP Central on a regular basis (schedule TBD)
Examples of information for Brockville, Ontario area:
Information sheets for your community should be obtained from the Ontario Prevention Clearinghouse (or a similar provincial organization) and distributed to the participants according their risk factor profiles. -
Appendix 8.1 CHAP Pharmacy-based Session Schedule (.doc)
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9.0 CHAP Program Wrap-up
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Appendix 9.1 Volunteer Peer Health Educator Survey (.doc)
A copy of the feedback survey to be administered to volunteer PHEs at the final debriefing session. -
Appendix 9.2 Final Report Template (.doc)
Local CHAP Coordinators are required to file a Final Report with the Regional Program Coordinator before the end of the Program. The template provided covers all of the necessary sections and information to be included.
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Appendix 9.1 Volunteer Peer Health Educator Survey (.doc)
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10.0 CHAP Mobilization Resources (UPDATED 2008)
- Appendix 10.1 Everything You Ever Wanted to Know About CHAP (.ppt)
- Appendix 10.2 Engaging Family Physicians (.ppt)
- Appendix 10.3 Implementation Overview and Timeline (.ppt)
- Appendix 10.4 Making the Most of CHAP Resources (.ppt)
- Appendix 10.5 Mobilizing Your Community and Group Progress Update(.ppt)
- Appendix 10.6 Volunteer Roles and Responsibilities (.ppt)
- Appendix 10.7 TIPS on obtaining educational pamphlets and resources for distribution at sessions (UPDATED 2008) (.doc)
- Appendix 10.8 CHAP Mobilization Final Report Template (.doc)
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11.0 CHAP Publication Guidelines
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12.0 CHAP Ethics & Privacy Information
Teleconference Minutes |
- Jan 11, 2008 (doc)
- Jan 15, 2008 (doc)
- Jan 31, 2008 (doc)
- Feb 2, 2008 (doc)
- Feb 25, 2008 (doc)
- Feb 28, 2008 (doc)
