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1. Diagnosis Plan -
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2. Diagnosis Plan
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3. Diagnosis Plan
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4. Diagnosis Plan
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5. Diagnosis Plan -
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Comments/other
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Pain Management Plan -
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Plan
• • •
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Comments/other
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Labs
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Lab Comments
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Radiology
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Comments/other
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DME Order(s):
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Other DME order(s):
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Home Health
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Home health comments
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Radiology
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Radiology Comments
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Referrals
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Referral Comments
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General Instructions
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General Instruction Comments
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Chronic Care Management
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CCM Comments/other
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Diet
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Comments/other
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Follow Up
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Comments/other
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Adv. Care Planning
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Comments/Other
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Care Plan
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Education:
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Comments/other
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Compliance
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Comments/other
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Signs of Emergency:
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Comments/other
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Diabetic Education & Counseling
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Diabetic Diet Discussion
• • •
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Prescribed Insulin Sliding Scale
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Education Comments
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