KOHP Forms


KOHP Forms


If you are a trained KOHP leader and are looking for the reporting forms for KOHP you have come to the right place.  Here is a quick timeline to help you organize your workshops.  The required forms are linked to the timeline for ease of use.  



At least 6 – 8 weeks before workshop

- Secure Workshop Co-leader

- Select and Confirm Meeting Room

- Select Workshop Dates and Times

- Order participants books from KOHP Coordinator
   at 785-296-1627 or AUnselt@kdheks.gov

-  Complete Program Scheduling Worksheet and
   send to KOHP Coordinator at 1000 SW Jackson, Suite
   230, Topeka, KS  66612 or e-mail to

- Determine registration procedures for workshop

4 – 5 weeks in advance

 - Promote program to recruit participants
    - church bulletins
    - organizations newsletters
    - community calendar in the local newspaper
    - see if you can’t get a story in the local paper
    - place participant fliers where people gather
        - physician offices
        - senior centers
        - worksite bulletin boards
        - local pharmacy
        - grocery store

- Register participants

1 week in advance

- Assemble Materials and Equipment
   - make sure the flipcharts are done

- Determine which leader is going to lead which
  activity each week

Days of Workshop

- Be on-site early to do final check and arrange

- Have each participant complete CDSMP Registration Form and DSMP Registration Form

- Each participant should also complete the Patient Activation Survey and the Self-Efficacy Survey (same for CDSMP and DSMP) at the first workshop.

- Record daily attendance on KOHP Class Attendance Form

- Conduct workshops

- Have each participant complete the KOHP Participant Feedback Form during the last class session.

- CDSMP Certificate of Excellence and DSMP Certificate of Excellence (given to each participant at last session of workshop).
- Self-Efficacy Follow-Up Form

1- 2 weeks after workshop ends

- Mail ALL forms to KSME Coordinator at 1000 SW Jackson, Suite 230, Topeka, KS 66612 or email to AUnselt@kdheks.gov.