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A recent census performed by the Department of Diabetes showed that of
380 in-patients (medical / surgical / elderly etc.) more than 110 had
Diabetes mellitus, mostly as co-morbidity. I receive between ten and fifteen
referrals per week to review "the Diabetes" of in-patients, probably half-and-half
from surgical and medical teams. To improve the quality and speed of reviews,
I would appreciate if you could complete the section below when referring.
It covers most aspects I will usually ask for as part of the assessment.
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Sticker
Name:
Age:
Hospital number
Date:
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Ward:
Referring team:
Bleep:
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| Diabetes F/U usually provided by: |
Next appointment due: |
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Year of diagnosis of diabetes: Is it: -
Type I / Type II / Type II on Insulin ?
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On Insulin since: |
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Eye disease:
· date and · findings on last dilated fundoscopy: · performed by:
Renal disease:
· Creatinine and · morning U - Albumin:Creatinine ratio
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Others:
· foot problems or · claudication or · ongoing angina ·
fasting lipids and · thyroid function and · HbA1c |
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Known ?
Hypertension:
Smoker (Never // Ex // Pack years) _________
Coronary disease
EtOH _________
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Cerebral disease
Weight and height // BMI _________
Periph. vasc. disease:
Family Hx of DM / CV disease
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| Your question: |
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Thank you for the referral. Feedback is very welcome as I am trialling
this form at present. If anything is unclear, give me a bleep.
Marcus Simmgen, SpR to Dr. Panahloo, bleep 6636
Asjid Qureshi, SpR to Dr. Nussey, bleep 6680 (only for known pts.
of Dr. Nussey)
v. 15.1.2001
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