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Diabetes Visit
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Last 2 weeks Home blood glucose readings, averages
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Low blood sugar episodes
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Most recent Hemoglobin A1c (goal <7%)
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Most recent LDL-C level w/in 1 year
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Most recent diabetes eye exam date:
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New Rx's from other providers
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New medical changes
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Increased thirst/hunger/urination?
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Weight change?
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Pneumovax 23 vaccine
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Last Influenza vaccine
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Exercise
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Diet
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Allergies
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Annual Physical Exam
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Anxious
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Asthma
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Attention Problems
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Back Problems
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Broken/ Fractured Bones
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Cold
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Cough
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Depression
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Dizzy
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Earache
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Diabetes
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Diarrhea
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Facial Questions
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Heartburn
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Headache
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Weekly Recur Exam
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Shoulder Pain
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Difficulty Breathing
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Neck Pain
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Difficulty Swallowing
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Wrist Pain
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Difficulty Urinating
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Eye Drainage
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Facial Pain
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Fever
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High Blood
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