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Diabetes Care Program SelfReferral Form To attend this program you must be: over the age of 18 have a confirmed diagnosis of Prediabetes or Diabetes (Type 1 or Type 2) Please complete the following
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How to fill out diabetes care program self-referral
How to fill out diabetes care program self-referral
01
Contact the diabetes care program office
02
Request a self-referral form
03
Fill out the form with accurate information about your medical history and current diabetes management
04
Submit the completed form to the diabetes care program office either in person or through email
Who needs diabetes care program self-referral?
01
Individuals diagnosed with diabetes who are seeking specialized care and support
02
Patients who want to take control of their diabetes management and improve their overall health
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What is diabetes care program self-referral?
Diabetes care program self-referral is a process where individuals proactively seek out care for their diabetes without a healthcare provider's referral.
Who is required to file diabetes care program self-referral?
Individuals with diabetes who wish to participate in a care program are required to file self-referral.
How to fill out diabetes care program self-referral?
To fill out diabetes care program self-referral, individuals must provide their personal and medical information, as well as their healthcare preferences.
What is the purpose of diabetes care program self-referral?
The purpose of diabetes care program self-referral is to empower individuals to take control of their diabetes management and seek out appropriate care.
What information must be reported on diabetes care program self-referral?
Information such as medical history, current symptoms, preferred healthcare provider, and treatment preferences must be reported on diabetes care program self-referral.
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