The Oregon Department of Human Services asks your assistance in collecting information about where Living Well programs are being offered across Oregon and who is participating. This information helps track statewide successes and identifies additional training, funding, and other support needs.

Please note that for every set of completed data forms received for either a Living Well or Tomando Control program (the Program Summary form and all completed Participant Information forms), DHS will send back 10 Living a Healthy Life with Chronic Conditions or Tomando Control de su Salud program books.

Report Online

To report program summaries and participant information, please use the forms below:

• Program Summaries can also be reported online! Please complete this at the end of each 6-week program you lead and submit data by mail or email to DHS within 2 weeks of completing the program.
• Upcoming Programs can now be submitted online! Please send us information about all upcoming programs, whether or not they're open to the public.  Include all information necessary for us to post the information on our online workshop calendar:  Workshop type, location, date, time, city, county and contact for registration.

Report via Fax/Mail

The following forms and memos explain the process of collecting and submitting data to The Oregon Living Well Program:

• Memorandum - Change to the Living Well Data Collection Process (pdf) - explanation of the new data collection process
• About this Workshop Survey Packet (pdf) - an overview of forms and usage for Living Well leaders
• Living Well Attendance Log (pdf) - use this form to track participant attendance
• Positive Self-Management Program Attendance Log (pdf) - use this form to track attendance for 7 weeks
• Tomando Control Registro de asistencia (pdf)
• Living Well Program Summary (pdf) - please provide information about your workshop on this form
• Tomando Control Resumen del programa (pdf)
• Living Well Participant Summary (pdf) - please have each program participant complete this form at the end of the first session they attend
• Tomando Control Informacion sobre el participante (pdf)
• Living Well Welcome letter (pdf) - this optional letter is provided to help explain data collection to workshop participants
• Tomando Control Bienvenido (pdf)

Faxing Instructions: Please fax documents to 971-673-0994 in care of Living Well with Chronic Conditions.

Mailing Address:
Living Well with Chronic Conditions
Health Promotion & Chronic Disease Prevention
800 NE Oregon St., Ste. 730
Portland, OR 97232