Diabetes Prevention Program Session Note (MDPP)

Diabetes Prevention Program Session Note (MDPP)

Session Date: [Date]

Session Phase: [Core / Core Maintenance]

Session Number: [Session number, e.g., Core 5 of 16 or Maintenance 2 of 6]

Delivery Modality: [In-person / Distance learning (synchronous) / Online (asynchronous)]

Curriculum: [CDC-approved curriculum name and module/topic]

Supplier: [Organization name, NPI, CDC DPRP code]

Coach: [Name, NPI]

Participant: [Name, DOB, internal ID]

Make-up Session Details: (Include only if this is a make-up session; omit entirely for regular sessions)

• Missed session being made up: [Missed session date and number]
• Same curriculum topic covered: [Yes / No]
• Occurred on same day as a regularly scheduled session: [Yes / No]

Attendance & Progress

Attendance: [Attended / Partial / No-show / Cancelled]

Distance learning attendance verification: [Method used to verify attendance] (Include only for distance learning/synchronous sessions)

Asynchronous module completion: [Module completion date] (Include only for online/asynchronous sessions)

Coach interaction attempt (asynchronous): [Modality] — [Contacted / Attempted, no contact] (Include only for online/asynchronous sessions)

Weight: [Value with units] obtained [Date] via [in-person measurement / self-report / digital scale transmission / medical record within X days] (If not obtained, document "Not obtained due to [reason]" and flag for resolution before billing; do not infer)

Baseline weight: [Baseline value with units and date]

Percent weight change from baseline: [Auto-calculated %]

Physical activity: [Number] minutes of moderate activity since last session on [Date] (Record 0 if none reported; do not leave blank)

Activity barriers: [Brief note on barriers such as injury, weather, schedule] (Include only if applicable)

Session Content

Education delivered:

• [Learning objective and teaching method]
• [Learning objective and teaching method]
• [Materials provided] (Include only if applicable)

Participant engagement:

• [Successes or positive changes since last session]
• [Barriers encountered]
• [Supports or facilitators identified] (Include only if applicable)

Assessment

[1–3 sentence progress statement synthesizing weight trend, activity level, and self-monitoring adherence; note readiness for next steps or areas needing support]

Milestones: 5% weight loss [Achieved on date / Not yet achieved]; 9% weight loss [Achieved on date / Not yet achieved]

Plan

SMART goals:

• [Goal: specific behavior, target, frequency, timeframe] — [Barrier mitigation strategy]
• [Additional goal and barrier mitigation] (Include only if applicable)

Self-monitoring/homework: [What to track, frequency, and submission method]

Next session: [Date and topic]

Clinical Issues

(Include this section only if clinically relevant events occurred; omit entirely for routine sessions)

• [Issue]: [Action taken or referral] — [Instructions provided to participant]

Coach Signature: [Name, credentials]

Date/Time Signed: [Date and time]

(Compliance notes: Weight, physical activity minutes, session modality, coach NPI, and curriculum identifier are required for MDPP billing. For Session 1, verify eligibility documentation is on file. Do not include other group participants' names in this note.)