Date: name: address: city: state: zip: re: blood glucose log sheet dear valued customer, thank you for allowing home care delivered to be your supplier of blood glucose testing supplies. due to the amount of times you are testing each day,...
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Information for you: if you need a new meter or more supplies, get a prescription from your doctor. if you have problems using the meter, talk with the pharmacist or your doctor. or call the abbott customer care 24hour support line at 15225226. be...
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Blood sugar log name: doctor: date: telephone: my target blood sugar ranges are ada blood glucose targets mg/dl to mg/dl before meals before breakfast: 70 to 130 mg/dl mg/dl to mg/dl 2 hours after meals 2 hours after meals:
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Capitalcare medical group blood sugar log provider comments: name: phone: (518) ok to leave message physician: id# diabetes medications: name dose time my blood sugar goals before meals: 80110 2 hours after meals: 80140 correction: 1 unit for...
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Screening can take 2 forms. many centres can carry out fundal photographywhere a photograph is taken of the back of you eye allowing a doctor to look forany changes on the retina. the photograph will serve as a permanent record. insingapore, the...
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Onetouch? gold can help you learn to live with diabetes, while you live your life without limits. enroll at .onetouchgold.com g51679-1 please detach and complete this form and return it to us in an envelope addressed to: lifescan p.o. box 49196,...
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Division of endocrinology patient name: office fax: (302) 651-5419 date of child s diagnosis: date breakfast time: snack time: lunch time: blood glucose log form phone we can reach you at: email: diabetesnemours nemours.org for non-emergency blood...
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Blue ridge family physicians, pllc 2605 blue ridge road, suite 300 raleigh, nc 27607 phone 9197873448 fax 9192326 .blueridgefamilyphysicians.com name phone glucose readings date during night before breakfast goals for blood pressure: before meals:...
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Fasting blood sugar log name: mrn: test your fasting blood sugar before breakfast and before taking or other medications. fasting blood sugar readings should range from 80 to 120 mg/dl. date blood sugar reading diabetes management program unc...
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Blood sugar log please bring this form to all doctors appointments (name): id #: ' (blood sugar log goals) (before meals): 90 130 mg/dl (two hours after meals): 90 180 mg/dl (bedtime): 90 150 mg/dl * * 2 2 2 date before breakfast 2 hours after...
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Please print/complete and bring in at your appointment circle one): internet,newspaper, commercial / tv, phone book, doctor (name) (if not patient).relationship to patient family history blood relatives (check all thatapply)
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Blood glucose log: pregnancy name: date of birth: date blood glucose target: fasting 90 one hour post meal: 120 3 am prebreakfast r r bg 1 hr post breakfast prelunch 1 hr post lunch pre dinner 1 hr post dinner bg bg bg bg bg remarks bedtime s sup...
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Practice enhancement examples blood glucose record a. enhancement objective a blood glucose record provides a log of patients' blood glucose readings to guide adjustments in pharmacotherapy for diabetes. 10 enhancement author: lisa mccarthy...
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Flow sheet for home blood glucose monitoring name: physician: prescribed frequency for monitoring: date fasting 2 hours after bkft. just before lunch 2 hours after lunch just before supper 2 hours after supper bedtime 3:00 am eastern carolina...
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If you have high blood glucose, make notes in your log and talk with your health care team about whether you need to change your meal plan, physical activity, or diabetes medicines. having low blood glucose means that your blood glucose level is...
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