Get the free INTEGRATED COMMUNITY DIABETES SERVICES REFERRAL FORM

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Interpreter required YES Language Date of Diagnosis Smoker DATE HbA1c Blood Pressure Waist Circumference Weight Kgs Cholesterol HDL LDL This information is required to facilitate education if not supplied referral will be returned HbA1c not required if IFG or IGT Reason for referral and additional information Retinopathy Yes Ex. Referral criteria IFG/IGT suitable for group education and fluent in English. DESMOND Diabetes Education Self-Management for Ongoing and Newly Diagnosed DESMOND meets...

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How to fill out integrated community diabetes services

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Step 1: Gather all the necessary information and documents needed to fill out the integrated community diabetes services form.

02

Step 2: Read the instructions and guidelines provided with the form to understand the requirements and procedures.

03

Step 3: Start by providing personal information such as name, contact details, and address.

04

Step 4: Fill out the medical history section, including any previous diagnoses, treatments, or medications related to diabetes.

05

Step 5: Provide information about current medications, if any, and any allergies or sensitivities.

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Step 6: Fill out the section related to lifestyle and dietary habits, including exercise routines, smoking or alcohol consumption, and dietary restrictions.

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Step 7: Answer any additional questions specific to the integrated community diabetes services program, if applicable.

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Step 8: Review the filled-out form to ensure all information is accurate and complete.

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Step 9: Sign and date the form as required.

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Step 10: Submit the filled-out form to the designated authority or healthcare provider for processing.

Who needs integrated community diabetes services?

01

Individuals diagnosed with diabetes who require comprehensive and coordinated healthcare services.

02

Patients with diabetes who need support in managing their condition through integrated care.

03

People with diabetes who would benefit from community-based resources and support systems.

04

Families or caregivers of individuals with diabetes who seek comprehensive care services in the community.

05

Healthcare providers and organizations involved in delivering integrated diabetes care services to the community.

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What is integrated community diabetes services?

Integrated community diabetes services are comprehensive programs that provide support and care for individuals with diabetes within a community setting.

Who is required to file integrated community diabetes services?

Healthcare providers, organizations, or community groups that offer diabetes services may be required to file integrated community diabetes services.

How to fill out integrated community diabetes services?

Integrated community diabetes services can usually be filled out electronically or on paper forms provided by the relevant healthcare authority.

What is the purpose of integrated community diabetes services?

The purpose of integrated community diabetes services is to improve the management, treatment, and support for individuals with diabetes in a community setting.

What information must be reported on integrated community diabetes services?

Information such as the number of individuals served, types of services provided, outcomes achieved, and resources utilized may need to be reported on integrated community diabetes services.

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