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Health Measure (Form A)
What is your measureable Health outcome?
What activity will you measure to achieve that outcome?
(Required)
The ONE activity you'll track (e.g., gym visits, meditation sessions, walks)
Current Baseline
(Required)
How many times per week/month do you do this activity NOW?
Ending Aim
(Required)
Total times you'll complete this activity over the entire 6-month measure.
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(Measure Difference Calculator)
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Name
First
Last
Date
MM slash DD slash YYYY
Activites This Period
(Required)
Number of times completed since your last submission
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Percent Complete
Optional Notes
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(Test Start Measure Int)
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Cumulative
Δ
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