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Examples for Goal Templates

Provider Suggested Goals

  •  Exercise

My SMART health goal is (Specific, Measurable, Action-based, Realistic, Time-lined):

To improve my health by exercising I will exercise [INSERT LENGTH OF TIME USING RANGES] [INSERT FREQUENCY PER WEEK/MONTH ETC.] and maintain through program completion.

 

I will verify I am working on achieving this goal by log, survey, calendar, paragraph summary, Epic documentation, journaling, etc., which I will provide to my advocate during a monthly and end of program follow-up call.

 

I understand that if I don’t complete monthly and end of program calls and provide monthly documentation, I will not be compliant with program expectations and, if eligible, risk not receiving the goal achievement incentive.  

I understand if I am eligible for a goal achievement incentive, it will be contingent upon the completion and achievement of the SMART goal(s) listed above by no later than December 18, 2020.

 

I will accomplish my goal by (examples):

  • joining a gym
  • exploring different types of exercises to find one I enjoy
  • finding a group of friends to exercise with
  • [INSERT VERIFICATION METHOD OF CHOICE – LOG, SURVEY, ETC.]


Provider Suggested Goals

  • Reduce Alcohol consumption

My SMART health goal is (Specific, Measurable, Action-based, Realistic, Time-lined):

To improve my health by reducing alcohol intake, starting [INSERT DATE] and maintaining through program completion, I will reduce the number of drinks containing alcohol from [INSERT RANGE] to [INSERT RANGE]. 

I will document that I am achieving this goal by log, survey, calendar, paragraph summary, Epic documentation, journaling, etc., which I will provide to my advocate before a monthly and end of program follow-up call. 

I understand that if I don’t monthly and end of program calls and provide monthly documentation, I will not be compliant with program expectations and, if eligible, risk not receiving the goal achievement incentive.  

I understand if I am eligible for a goal achievement incentive, it will be contingent upon the completion and achievement of the SMART goal(s) listed above by no later than December 18, 2020.

I will accomplish my goal by (examples):

  • Reducing the number of drinks I have during a day/week/month
  • Reducing the amount of alcohol I buy or keep in the house
  • Attending weekly AA meetings at …
  • Consider seeing the BeWell counselor for up to six sessions
  • [INSERT VERIFICATION METHOD OF CHOICE – LOG, SURVEY, ETC.]


Provider Suggested Goals

  • INSERT PROVIDER RECOMMENDATIONS

My SMART health goal is (Specific, Measurable, Action-based, Realistic, Time-lined):

To (e.g. improve my health by increasing walking, I will walk) [INSERT FREQUENCY RANGE, OR MISC GOAL OF CHOICE] for [INSERT RANGE OF TIME OR DISTANCE, EXAMPLE OF FINANCIAL GOAL, ETC.] and maintain through program completion. 

I will verify I am working on achieving this goal by log, survey, calendar, paragraph summary, Epic documentation, journaling, etc., which I will provide to my advocate during a monthly and end of program follow-up call. 

I understand that if I don’t complete monthly and end of program calls and provide monthly documentation, I will not be compliant with program expectations and, if eligible, risk not receiving the goal achievement incentive.  

I understand if I am eligible for a goal achievement incentive, it will be contingent upon the completion and achievement of the SMART goal(s) listed above by no later than December 18, 2020.

 

I will accomplish my goal by (examples):

  • mapping out routes to walk
  • scheduling time to walk during my day
  • finding someone to walk with
  • [INSERT VERIFICATION METHOD – LOG, SURVEY, ETC.]