The TSWF Metabolic CPG AIM form is intended to be used in primary care settings for documenting the care of patients diagnosed with diabetes, dyslipidemia, hypertension, and/or obesity.

Nav - CV - COT - Clin - CORE - Ger - LBP - Met - MPHA - Nrs - Proc - Pulm

Training Material for All Users

AHLTA and other training resources

Additional TSWF support

Metabolic Recent Changes

  • 13 changes for Jan-Apr 2018 update
  • Added a clinical cue to the Family History text box (“Including, but not limited to, diabetes, heart disease, HTN, colon cancer, breast cancer, and/other cancers, and conditions that run in the family.”)
  • Added a clinical cue to the PHQ-9 ribbon (“If clinical judgement suggests, and/or patient is on anti-depressants and has a history of depression, skip PHQ-2, open ribbon, and go directly to PHQ-9.”)
  • Changed ribbon wording to: Depression Screening (PHQ-2 and PHQ-9)
  • Renamed the “Sexual Assault Toolkit” ribbon as “Sexual Assault Resources”
  • Removed the Overall Health question
  • Removed Secure Messaging question from Annual Questions field
  • Added REALM SF details and words to the forms (listed individually)
  • Placed the REALM SF scoring chart to the right of the text box with instruction:
    “The score is based on the number of words correctly read aloud.”
  • Consolidated MSK upper and lower into one tab
  • Reformatted Red Flags field
  • Moved Lifestyle/Exercise questions to Exit CCP tab
  • AUDIT-C revision:
    -Deleted previous AUDIT-C score field
    -Added AUDIT-C score to the existing date field
    -Reformatted clinical information
  • Deleted the Allergies field and added blue cue text explaining the change



  • Focused documentation of metabolic disorders
  • Similar to CORE form
  • Follows VA/DoD CPGs

The Metabolic CPG AIM form was created with two major objectives in mind. The first objective was to focus the documentation of care for patients with diabetes, dyslipidemia, hypertension, and/or obesity, with associated clinical decision support elements embedded in the form. Secondly, the form was designed to be very similar to the TSWF CORE form. This was done in order to minimize the learning curve, while allowing for those “oh, by the way, doc” patient concerns without having to switch AIM forms. The template is updated from time to time as new evidence emerges. VA/DoD Clinical Practice Guidelines are the main source for clinical recommendations related to the four conditions.

Form Lead

TSWF Metabolic Form Lead
Dr. James Neville, MD, MPH, FACPM

Tri-Service Workflow is dedicated to serving those who serve. Our innovations bring the team care we exemplify to help you in your patient care.