Get the free Diabetes Program Referral - Adult Form - Alberta Health ...
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Patient Last Name, First Name. PhD/Edmonton Prescreening COLONOSCOPY REFERRAL Page 1 PHONE 7803420180Gender: M/DOB (DD/MMM/YYY)Street Address FAX: 7803420311email: scope AHS.caCityNOTE All referrals
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How to fill out diabetes program referral
How to fill out diabetes program referral
01
Obtain a referral form from your healthcare provider or diabetes program.
02
Fill out your personal information on the referral form, including your name, date of birth, and contact information.
03
Provide details about your diabetes diagnosis, such as the date of diagnosis and the type of diabetes you have.
04
Include information about your current diabetes management plan, including any medications you are taking and any medical devices you use.
05
If applicable, mention any additional medical conditions or complications related to your diabetes.
06
Sign and date the referral form.
07
Submit the completed referral form to the diabetes program or healthcare provider's office as instructed.
Who needs diabetes program referral?
01
Individuals who have been diagnosed with diabetes and require specialized diabetes education, support, and management can benefit from a diabetes program referral.
02
This may include individuals who are newly diagnosed and need guidance on managing their diabetes, as well as those who have been living with diabetes for a while but want to further improve their self-care skills.
03
Diabetes program referrals are often recommended for individuals who may be at higher risk for diabetes-related complications or require additional support in managing their diabetes effectively.
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