|
Hemoglobin A1C
|
|
|
Date of last A1C
|
|
|
Microalbumin/Creatinine Ratio
|
|
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Date of last Microalbumin
|
|
|
Podiatrist this year?
|
|
|
Ophtho this year?
|
|
|
Monofilament foot exam today?
|
|
|
Monofilament comments:
|
|
|
Blood Pressure
/
|
|
|
Fasting Lipids within last year?
|
|
|
Antiplatelet Therapy?
|
|
|
Serum Creatinine
|
|
|
Date of last Serum Creatinine
|
|
