Office of Rural Programs
Ambulatory Scripts: Diabetes
| History | Hx diabetic ulcer(s) | ||
|---|---|---|---|
| +/- macrovascular complications cerebrovascular cardiovascular |
+/- progression of associated ROS | ||
| +/- microvascular complications neuropathy of __ (distal/autonomic) nephropathy- Cr, GFR retinopathy- optho report |
+ current Tx | +/- progression of associated ROS | |
| Interim | home BG range/changes +/- lows <70 (BG), +/- associated ROS |
||
| Meds | glycemic meds/insulin OR No meds due to ______ OR Diet/lifestyle managed +/- statin, ACEi/ARB, ASA |
____ units of ____ @ ____ | |
| Labs | A1c, alb/Cr or microalb | previous A1c | |
| Vitals | BP, PR, BMI | ||
| PE | monofilament, abnormals |
Table last updated 2/15/2023 | Script Index | Feedback: rgree3@uw.edu | Download pdf for printing