Diabetes Care Flowsheet. Patient Name Male Female DOB Height. Co-Morbid Conditions: Type 1 or 2 diabetes. Date of Service (Record result) QUARTERLY …
Diabetes Care Flowsheet
Patient Name Male Female DOB Height
Co-Morbid Conditions: Type 1 or 2 diabetes
|Date of Service Record | | | | | | |
|result | | | | | | |
|QUARTERLY |Blood | | | | | |
| |Pressure | | | | | |
| |Goal | | | | | |
| |130/80 | | | | | |
|ANNUALLY OR PERIODICALLY |LDL | | | | | |
| |Goal 100| | | | | |
| |mg/dl | | | | | |
|ANNUALLY OR PERIODICALLY |LDL | | | | | |
| |Goal 100| | | | | |
| |mg/dl | | | | |
|
QUARTERLY
|Blood Pressure
Goal 130/80 | | | | | | | | |Self Management Goals
State goal
| | | | | | | | |Review Blood Glucose Record
State range | | | | | | | | |A1C Goal 70 May be done semi-annually or
annually if well-controlled | | | | | | | | |ACE Inhibitor
? Contraindicated | | | | | | | | |Aspirin 80mg/d
| | | | | | | | |
| | | | | | | | |
| | | | | | | | |
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