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OUTPATIENT DIABETES EDUCATION REFERRAL PATIENT INFORMATION DIAGNOSIS: (check appropriate boxes) Name: Address: Type 1 uncontrolled controlled Type 2 uncontrolled controlled Gestational or Pregnant
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Start by opening the document entitled "diabeticedreferral - colglazier demmel" on your computer or printing out a physical copy.
02
Fill in your personal information in the designated areas, such as your name, address, phone number, and email address. Make sure to double-check for any typos or errors.
03
Next, provide any relevant medical information regarding your diabetes. This may include your diagnosis date, current medications, and any specific treatment plans you are following.
04
In the referral section, indicate the healthcare provider or specialist you are being referred to for your diabetes management. Include their contact information if available.
05
If you have any specific requests or concerns, use the additional comments section to communicate them clearly. This can include any specific topics you would like to discuss with the healthcare provider or any questions you may have.
06
Finally, review the completed form to ensure all necessary information has been included and is accurate. Make any necessary edits or additions before submitting it.

Who needs diabeticedreferral - colglazier demmel:

01
Individuals who have been diagnosed with diabetes and are seeking specialized care or treatment.
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Patients who require referral to a healthcare provider or specialist better equipped to handle diabetes management or related issues.
03
Individuals who are interested in getting a second opinion or exploring alternative treatment options for their diabetes.
Note: It is always recommended to consult with a healthcare professional or your primary care provider for personalized advice and guidance regarding your specific medical condition and referral needs.
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Diabeticedreferral - colglazier demmel is a referral form for diabetic education services provided by the Colglazier Demmel Institute.
Healthcare providers and educators who are referring a patient for diabetic education services are required to file diabeticedreferral - colglazier demmel.
To fill out diabeticedreferral - colglazier demmel, the referrer must provide basic patient information, reason for referral, and any relevant medical history.
The purpose of diabeticedreferral - colglazier demmel is to ensure that diabetic patients receive appropriate education and support to manage their condition effectively.
Diabeticedreferral - colglazier demmel must include patient demographics, medical history, reason for referral, and any specific needs or concerns.
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