AOA Diabetic Eye Examination Report www. aoa.org From To Date examined Write in or apply company stamp Patient Information DOB Name Diabetes mellitus Type 1 Type 2 Duration of Diabetes in years Gestational Current Diabetes Therapy Results of Last Finger-stick blood glucose reading per patient 6 months HbAlC Prediabetes N/A Oral Hypoglycemic Unknown None Diet Contol Patient reports under control Yes No Current Medications ocular and systemic Exam Findings Visual Acuity best corrected...
aoa diabetic eye exam report

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