Diabetes follow-up
Internal medicine

Blank documentation outlines. Adapt to the encounter and your practice requirements; complete only findings and care actually documented.

ENCOUNTER
Patient name: [ ]
Date of birth: [ ]
Date and time of encounter: [ ]
Clinician: [ ]

INTERVAL HISTORY
Changes since the previous visit: [ ]
Low blood sugar episodes, timing and treatment as reported: [ ]
Medication and insulin use as reported, adherence and adverse effects: [ ]
Diet, activity and barriers to self-management: [ ]

GLUCOSE DATA
Most recent A1C with date: [ ]
Home glucose or continuous glucose monitor data reviewed, with dates and source: [ ]

MONITORING
Vitals measured today, with units: [ ]
Foot examination performed and findings: [ ]
Eye examination status and date: [ ]
Kidney monitoring results with dates: [ ]
Lipid results with date: [ ]

ASSESSMENT AND PLAN
Current control and supporting data: [ ]
Medication decisions and rationale: [ ]
Agreed targets: [ ]
Orders, referrals and education provided: [ ]

FOLLOW-UP
Follow-up timing and purpose: [ ]
Return precautions discussed: [ ]
Patient questions and understanding: [ ]