to conduct a Chart Review of five (5) self-selected patients with diabetes. your obligation to the research element of the Frontline: Diabetes preceptorship. …
Frontline: Diabetes
Chart Review Summary Sheet
Resident Name:_________________________ Date:_______________
Patient YEAR of Birth ___/___/___/___ ie 1970
| |Yes |No |
| | | |
|LABORATORY |
|Hemoglobin A1c in the past 6 months? | | |
|Fasting lipid profile been obtained in the past 12 months?| | |
|Urinalysis or test for microalbuminuria in the past 12 | | |
|months? | | |
| | | |
|PREVENTIVE CARE |
|Influenza vaccination in the past 12 months? | | |
|Foot examination in the past 12 months? | | |
|Referral for dilated retinal eye examination | | |
|ophthalmology in the past 12 months? | | |
|
| | |
|SMOKING |
|Assessment of smoking status? | | |
|If smoking, was counseling provided? | | |
| | | |
|ASPIRIN USE |
|Assessment of aspirin use? | | |
|If not, is a contraindication eg aspirin allergy, | | |
|bleeding tendency, anticoagulant therapy, recent | | |
|gastrointestinal bleeding, clinically active hepatic | | |
|disease noted? | | |
| | | |
|LIFE-STYLE COUNSELING |
|Were the following life-style issues discussed? |
|Exercise | | |
|Nutrition | | |
|Diabetic education | | |
Instructions prior to the
workshop:
Each participant will be required to conduct a Chart Review of five 5
self-selected patients with diabetes Please use this form to record the
data from your chart reviews and enter the information at our website
http://wwwafmrdorg no later than two weeks prior to the workshop date you
have selected This process will take approximately 5-7 minutes to enter
your data online
Instructions following the workshop:
At six months following the workshop or by May 31st for graduating 3rd year
residents, participants will be contacted via email to complete online a
post/post-test and a second chart review of five 5 self-selected patients
with diabetes Please use this form to record the data from your chart
reviews and enter the information at our website http://wwwafmrdorg
This process will take approximately 5-7 minutes to enter your data online
These elements, including the on-site post-test and interactive Quality
Improvement web exercise at http:/wwwwwwafmrdorg/qi, fulfill your
obligation to the research element of the Frontline: Diabetes
preceptorship For more information regarding the research component and
program objectives of this project, please
visit
http://wwwafmrdorg/diabetes/programcontenthtml
Source:mbari.org
