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Diabetes Care Card

TESTS (How often) DATE OF VISIT
Hemoglobin A1c (every 3 months)___/___/___
Weight (every visit)___/___/___
Foot Exam (every visit)___/___/___
Blood Pressure (every visit)___/___/___
Cholesterol HDL/LDL (once a year)___/___/___
Triglycerides (once a year)___/___/___
Microalbuminuria (every visit)___/___/___
Eye Exam (once a year)___/___/___
Dental Exam (once a year)___/___/___
Flu Shot (once a year)___/___/___
HAVE YOU REVIEWED 
Meal Plan___/___/___
Exercise Plan___/___/___
Blood Sugar Testing___/___/___
Low/High Blood Sugar___/___/___
Safety Check on Meter___/___/___
Foot Care___/___/___
Drawing and Injecting Insulin___/___/___
Syringe Disposal___/___/___
Sick Day Management___/___/___
Stress Management___/___/___
Member of:
ADA/JDFyes or no
Support Groupyes or no
___/___/___

Print this card and take it with you to the doctor.

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