2. Time Frame for Self-care Measures
Each symptom evaluation chart has a suggested time frame for using self-care measures.
The time frame is underlined and in italics.
If you don’t start to get better within the suggested time frame, see a health care provider.
If at any time you think your minor illness is getting worse, see a health care provider. 
Emphasize the time frames listed for each self-care measure.
For example, the guidance for Ear Pain is “Go to sick call if the ear pain doesn’t get better within 24 hours or the pain keeps you from your duties or activities.”
If the self-care measures do not work within the time frame, the soldier should go to sick call.
If at any time the symptoms get worse, the soldier should go to sick call.
Class participants may choose another example from the Symptom Evaluation Charts to illustrate time frames for self-care measures.

3. Treatment requests will be limited to five items.
Sample
Green Sheet
TROOP MEDICAL CLINIC (TMC) SELF-CARE PROGRAM TREATMENT OPTIONS FOR SYMPTOMS/CONDITIONS
I am aware that I am participating in a self-care program. I understand that to properly perform self-care and safely treat any symptom(s) of conditions(s) that I may have during training I must follow the symptom evaluation charts. I also understand that I am responsible for carefully following the directions for use of any medication received through this program. I verify that I have read the self-care decision guide and the recommendations provided therein. I also verify that I am requesting treatment options(s) voluntarily. I also agree that I will not share medication with anyone and that I will be the sole user.
What allergies, to include medications, do you have?_________________________________________
What medicines are you presently taking? ______________________________________________
Print Name Print SSN Date
Signature  Unit: Sex: M F
INSTRUCTIONS: After reading the Soldier Health Maintenance Manual and identifying the proper treatment option(s), find the symptom(s)/condition(s) that you have on the list below. Circle it. Then follow the line across to find the treatment option(s) for your symptom(s)/condition(s). Circle the treatment you would like to receive. Request the identified treatment option(s) from the Consolidated Troop Medical Clinic Pharmacy.
Treatment requests will be limited to five items.
NOTE: You can select Daytime OR Robo DM liquid but NOT BOTH.
You can select Daytime OR SudaGest, but NOT BOTH.
The Self-care Program green sheet is used to get OTC medications from the clinic pharmacy.
The green sheet is used for participants in the Self-care Program only, not for sick call.
Drill sergeants should only give the green sheet to soldiers who have completed the Self-care class.
Note: A soldier cannot report the same complaint for two consecutive self-care visits.
A sample of the green sheet is included in the self-care class brief.
An example of a completed green sheet may be distributed to all class participants.

4. SAMPLE SYMPTOM/CONDITION: TREATMENT OPTION
Acne Medication (Benzoyl Peroxide)
Allergies & Hay Fever SudaGest Decongestant (Pseudoephedrine)*
Athletes Foot Miconazole Nitrate Antifungal Cream
Blisters Mole Skin
Band-Aid
Bacitracin Antibiotic Ointment
Baby Powder (Talc)
Constipation Genasoft (Ducosate)
Cough with congestion Daytime*
Cough (dry) Robo DM liquid*
Cut or Scrape Bacitracin Antibiotic Ointment
Band-Aid
Diarrhea Anti-Diarrheal (Loperamide)
Earache Ibuprofen Tablets
Headache Ibuprofen Tablets
Heat Rash Baby Powder (Talc)
Insect Bite Calamine Lotion
Cortaid Cream (Hydrocortisone)
Jock Itch Miconazole Nitrate Antifungal Cream
Baby Powder (Talc)
Muscle Pain & Inflammation Ibuprofen Tablets
Nasal or Sinus Congestion (without cough) SudaGest Decongestant (Pseudoephedrine)*
Poison Ivy/Oak/Sumac Cortaid Cream (Hydrocortisone)
PreMenstrual Syndrome Ibuprofen Tablets
Ringworm Miconazole Nitrate Antifungal Cream
Runny Nose or sneezing SudaGest Decongestant (Pseudoephedrine)
Sore Throat Cepacol
Upset Stomach Maalox Antacid Plus
Vaginitis Gyne-Lotrimin (vaginal insert)
SAMPLE

5. YELLOW SHEET Self-care Program Evaluation (Program Participant—Soldier)
Instructions
Please complete Part 1 and Part 2.
Your responses are very important to the Self-care Program. This information is completely confidential and will only be used to improve the program. Please write any additional comments at the bottom of the page. Return the completed form to the proper pick-up location. Thank you.
Part 1
Date: ___/___/___
Installation: ______________________
Unit: ______________________________
MOS: ______________
Please circle one response for each of the following:
Age: 18 – 19 – 20 – 21 – 22 – 23 – 24 – 25 – Over 25
Sex: M F
Highest education level completed:
GED – High school – Some college – College graduate
1. The yellow sheet is used to evaluate the Self-care Program. This evaluation collects some basic demographic information and asks some basic questions about the Self-care Program.
2. The yellow sheet is distributed to soldiers by the drill sergeant at the end of the training cycle.
3. The Self-care Program coordinator will collect all yellow sheets from the drill sergeants.
4. A complete sample of the yellow sheet is included in the self-care class brief.

6. Yellow Sheet: Part 2
 Please circle one response for each of the following questions. If not sure, leave that question blank.
1.  I used the Self-care manual at least once to take care of myself. Yes No 
2.  I made at least one clinic visit for Self-care using the Green Sheet. Yes No
3.   I made at least one clinic visit for regular Sick call Yes No
4.   The Self-care Program helped me to avoid missing training time at least once. Yes No
5.  I would feel comfortable following the Self-care steps in the manual if I needed to. Yes No 
6.  The Self-care Program is a valuable benefit for my own health. Yes No
7.  The Self-care training and manual taught me how to take better care of myself. Yes No
8.  When I can, I prefer to use the Self-care Program instead of regular Sick call. Yes No
9. The training and manual helped me decide whether to use Self-care or regular Sick call . Yes No
10.  The Self-care Program should be available to all soldiers Yes No

7. Presentation Self-care class presentation
Inform the instructors that you will be doing the self-care class presentation as if they are an audience playing the role of young soldiers.
Tell instructors they should observe this process so that they can conduct it in a practice mini-teach-back, if time is adequate.
“See one, do one, teach one” . Instructors will see this presentation and then instructors will do one presentation to teach back what they learned.
Present the self-care class. Close by asking for questions from the audience still in the role of a young soldier.

8. Mini Teach-Back Objective:
To practice doing the self-care class in front of a group in a non-threatening situation.
A teach-back is a short practice session that helps you to become familiar with presenting self-care class materials.
Highlight three main points about self-care.
Describe/define self-care process
Use manual and symptom evaluation charts exercises.
Select appropriate OTC items from green sheet from a scenario.
1. A teach-back is a short practice session (usually limited to 15 minutes) which allows instructors an opportunity to become familiar with presenting key class materials: the Soldier Health Maintenance Manual, the Self-care Program, self-care process flow chart, and the green and yellow sheets.
2. Present the self-care class; use the audience playing the the role of young soldiers.
Remind the instructors that they should also observe teaching process to prepare them for the teach-back.
3. Instructions for the teach-back. Use minutes to prepare 3- to 4-minute presentation highlighting elements of the Self-care Program.  
4. Inform the instructors that they will now do a teach-back explaining the self-care process and the green sheet.  Review the objectives and points listed on the slide.
5. Suggested teach-back elements:
Definition and description of self-care
Self-care process
Symptom evaluation charts
Demonstrate use of the Soldier Health Maintenance Manual
Using the green and yellow sheets
Ask for feedback from each mini teach-back presentation.
The “Evaluation of Teaching Performance” form can by used by the trainer to provide feedback.

9. Important Points to Remember
Soldiers cannot share OTC medications with their buddies.
OTCs can mask serious symptoms.
Know the difference between non-emergency and emergency symptoms.
The five requested OTCs on the green sheet must be related to the chief medical complaint.
These points should be emphasized throughout the self-care class presentation.

10. Tracking Mechanisms
Submit a class roster or attendance sheet to the Self-care Program Coordinator or to the pharmacy.
Self-care stickers should be placed on ID cards of soldiers who complete the class.
Green sheets are only to be used by soldiers who have completed the self-care class.
These tracking mechanisms ensure that only soldiers who have had the self-care class are able to use the Self-care Program.
The class roster is logged by the pharmacy to record all soldiers eligible to use the Self-care Program.
Soldiers are to display the ID card with the sticker to the pharmacist to confirm eligibility for the Self-care program. This is an optional tracking mechanism that can be developed locally.
Drill sergeants are to give green sheets only to soldiers who have had the class. Soldiers who have not had the class are not eligible to use the Self-care Program.

11. Self-care Quiz
The Self-care Quiz is an optional portion of the class . It is highly recommended. It is recommended to be administered at the conclusion of the class. You may choose to use the quiz as a pre-test (before the class) and post-test (after the class).
This quiz can be used to immediately assess knowledge and understanding about self-care and the Self-care Program.
There are 10 questions.
7 questions require “true or false” answers.
1 question requires “yes” or “no” answer.
2 questions ask about use of self-care process vs. sick call.

12. Administering the Quiz
Projection on to the screen/wall via an overhead projector.
Print quiz on both sides of paper indicating pre-test and post–test or have student indicate pre/post test.
Place on the back of the yellow sheet and use as a final assessment of knowledge and understanding of the self-care.
The terms OTC medications and self-care medications are used synonymously.
There are several ways to administer this quiz, as shown on the slide.
The quiz can be taken by instructors to enable them to become familiar with the materials. The average completion time is 3 minutes.

13. Questions? Ask for questions.
Give the instructors their packet of materials: Soldier Health Maintenance Manual, briefing slides, green sheets, yellow sheets, sample sick call slips (white sheets), Self-care Quiz, and other reference materials.
Review these materials with instructors.
Tell the instructors that their teaching will be evaluated by the trainer/program coordinator at a later time. Distribute and review the instructor evaluation form titled “Evaluation of Teaching Performance”.
Stress to the instructors that this is a volunteer opportunity.
Emphasize the importance of volunteerism and the importance of being viewed as a role model for new recruits.
You may choose to give an incentive such as t-shirt, pins, or books for publicity.
Thank all participants for volunteering to teach the class.

14. Self-care Quiz
1. Self-care is taking care of your own health for treatment of minor health problems.
a. True
b. False
2. I can get up to 5 self-care medications for minor health symptoms that I might have.
Answers:
a. True
Why?
Explain answer. Use definition in manual to reinforce key messages.(page 1-2)
Explain answer. Use green sheet to reinforce answers.

15. Self-care Quiz
3. Ibuprofen tablets are available through the Self-care Program.
a. True
b. False
4. To use the Self-care Program, I have to fill out a “green sheet.”
5. If I answer “yes” to a question on a symptom evaluation chart, I must use sick call.
Give and explain answers.
Use manual, symptom evaluation charts and green sheet to reinforce answers.
3. a. True
4. a. True
5. a. True

16. Self-care Quiz
6. I can share medications from the Self-care Program with my battle buddies.
a. True
b. False
7. Information about over-the-counter (OTC) medications is located in the Soldier Health Maintenance Manual.
8. The pharmacist can answer questions that I may have about OTC medications.
a. Yes
b. No
6. b. False
7. a. True
8. a. Yes

17. Self-care Quiz a. Get medical help right away.
9. If I have severe pain and vomiting, I should:
a. Get medical help right away.
b. Use the Self-care Program.
10. If I have a symptom that is not in the book, I should use:
a. The Self-care Program.
b. Sick call.
9. a. Get medical help right away.
10. b. Sick call.