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1.
Type of Diabetes
2.
Year Diagnosed
3.
Height
4.
Weight
5.
Blood Pressure
6.
Glucose Control
7.
Glucose Data (Checks Per Day, Hypoglycemic
Events Per Month)
8.
Referrals
9.
Tobacco Use
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10.
Alcohol Use
11.
Foot Exam
12.
Dilated Eye Exam
13.
Medication Use (ACE/ARB, Aspirin, Statin)
14.
Most Recent Dental Exam
15.
Most Recent Physical
16.
Date of Flu Shot
17.
Pneumovax Status and Year Received
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18.
Ekg Exam
19.
Date of Last Dietician Visit
20.
Date of Last Education Visit
21.
HgbA1c
22.
Lipids
23.
Creatinine
24.
Urinanalysis/Protein
25.
Urine Microalbumin/ Microalbumin Creatinine
Ratio
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