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Diabetes Prevention Program Health Care Provider Referral Form Complete this form and fax or email to the Diabetes Prevention Program Navigator at 18663362329 or referral HHS.NC.gov CLIENT INFORMATION
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How to fill out diabetes prevention program health

01
To fill out the diabetes prevention program health form, follow these steps:
02
Start by providing your personal information such as your name, date of birth, and contact details.
03
Answer questions about your medical history, including any previous diagnosis of diabetes or related conditions.
04
Provide information about your lifestyle habits, such as your dietary choices, physical activity level, and smoking habits.
05
Fill out any specific questions or assessments related to diabetes risk factors, such as family history of diabetes or high blood pressure.
06
Review and double-check all the information you have entered to ensure accuracy.
07
Submit the completed form as per the instructions provided by the diabetes prevention program.
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If required, follow up with any additional documentation or steps as requested by the program.

Who needs diabetes prevention program health?

01
Diabetes prevention program health is recommended for individuals who:
02
- Have prediabetes and want to prevent the onset of type 2 diabetes.
03
- Have high-risk factors for diabetes, such as obesity, sedentary lifestyle, or gestational diabetes during pregnancy.
04
- Want to improve their overall health and reduce the risk of developing chronic diseases.
05
- Have a family history of diabetes.
06
- Are ready to commit to making positive lifestyle changes to promote better health.
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Diabetes prevention program health focuses on educating individuals on healthy lifestyle choices to prevent the development of diabetes.
Healthcare organizations and providers offering diabetes prevention programs are required to file diabetes prevention program health.
Diabetes prevention program health can be filled out by providing information on the program's objectives, target audience, activities, and outcomes.
The purpose of diabetes prevention program health is to promote healthy behaviors and reduce the risk of diabetes in at-risk populations.
Information such as program goals, outcomes, participant demographics, and activities must be reported on diabetes prevention program health.
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