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DIABETES EYE EXAM REPORT Fax to Health Partners: 9106864715 or Mail to Health Partners: 1013 Porters Neck Rd., Suite 100; Wilmington, NC 28411 Fill in the following information and take to your eye
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Start by carefully reading the instructions on the form. Make sure you understand all the requirements and sections of the form.
02
Provide your personal information accurately. This may include your full name, date of birth, contact information, and any identification numbers required.
03
Fill in your medical information. Include details about your diabetes diagnosis and any relevant medical history.
04
If applicable, provide information about your primary care physician or any other healthcare professionals involved in your diabetes management.
05
Pay attention to the eye exam section of the form. You may be required to provide specific details such as the date of your last eye exam and the name of the eye care provider.
06
If the form includes a section for test results, make sure to attach any relevant documents or test results as instructed.
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Carefully review the completed form for any errors or missing information. Double-check that all sections are filled out accurately.
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Who needs health-partners-diabetes-eye-exam-formpdf:

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Individuals who have been diagnosed with diabetes and require regular eye exams as part of their diabetes management.
02
Patients who are under the care of Health Partners or a healthcare provider associated with Health Partners.
03
Those who are required to provide documentation of their eye exams for insurance purposes or other healthcare-related reasons.
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health-partners-diabetes-eye-exam-formpdf is a form used for reporting diabetes eye exam results to health partners.
Healthcare providers and patients with diabetes are required to file health-partners-diabetes-eye-exam-formpdf.
Health-partners-diabetes-eye-exam-formpdf can be filled out by entering patient information, exam results, and signing the form.
The purpose of health-partners-diabetes-eye-exam-formpdf is to monitor and track diabetes eye exam results for patients.
Information such as patient demographics, exam date, exam results, and healthcare provider information must be reported on health-partners-diabetes-eye-exam-formpdf.
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