Issuu on Google+

Page 1 of 6

Edit Clinical Notes AOHC - Diabetes Education

i Narrative View n j k l m n j Template View k l m

Vital Signs

c Premature d e f g graph sheet

HT:

graph sheet

WT:

Add BP CM KG

percentile:

Mother's Stature

percentile:

Father's Stature

HT/WT:

percentile:

BMI:

percentile:

Add PEFR CM CM

Status:

BSA: graph sheet

Systolic

graph sheet

CM

WC:

BP:

Diastolic

Limb

Adult

/

graph sheet

HR:

BPM:

Rhythm:

graph sheet

RR:

BPM:

Desc:

graph sheet

T:

graph sheet

SpO2:

graph sheet

Cuff Size

PEFR:

graph BS: sheet Client / Visit Type

째C

Date 5

2

2013

^ DD/MM/YYYY

Desc:

Location:

i pre-bronchodilator n j k l m n j post-bronchodilator k l m

L/min

5

2

2013

^

DD/MM/YYYY

mmol/L

j Template View k l m i Narrative View n j k l m n

Client Type:

Visit Type:

Referred by:

Other:

j Template View k l m i Narrative View n j k l m n

History Diagnosed:

Type:

Newly Diagnosed Previously Diagnosed & Not seen within 2 Years

When do you do Self-Monitoring Glucose: Never Before meals 2 hours after meals Bedtime 3 AM Other

Other:

Type 1 Type 2 Diet Type 2 ADA Type 2 ADA & Insulin Type 2 Insulin Pre-diabetes

Blood SelfMonitoring Blood Glucose:

Blood Glucose Date Range:

5

https://ont.nightingale.md/nic/patients/progressnote/ProgressNoteDataForm.asp?GETCLINI... 2/5/2013


Page 2 of 6

5

3 AM Other Frequency of Hypoglycemic Episodes:

6 Skipped meal Delayed meal Insufficient carbohydrate intake Increased/unplanned activity Problem with Medication/insulin dose

None Daily Several times/day Weekly Several times/week Monthly Several times/month

Do you Smoke?

Reasons for Hypoglycemic Episodes:

Are you trying to stop smoking?

Episodes: Hypoglycemic Date Range:

Smoking Packs/Day:

Wants help to stop smoking Not interested in stopping Stopped 6 months ago Stopped 1 year ago Stopped 1+ years ago

Yes No Used to

Number of Hypoglycemic

Smoking Status Date:

ASA Use: ASA Use: Yes No

5

ASA Use Date:

6 ACE Inhibitor/ARB Use:

ACE Inhibitor/ARB Use: Yes No

5

ACE Inhibitor Date:

6 Erectile Dysfunction:

Erectile Dysfunction: Yes No

5

6

Erectile Dysfunction Date:

Dilated Eye Exam Done: g c d e f

Neurological Exam done:

Dilated Eye Exam Date:

Foot Exam done:

c d e f g

Foot Exam Date:

c Neurological Exam Date: d e f g

Fasting Glucose Meter Calibration: g c d e f

Fasting Glucose Meter Calibration Date:

j Template View k l m i Narrative View n j k l m n

Nutritional Risk Factors: Age: g c d e f Age Comments:

5

Sepsis: g c d e f Sepsis Comments:

5

https://ont.nightingale.md/nic/patients/progressnote/ProgressNoteDataForm.asp?GETCLINI... 2/5/2013


Page 3 of 6

6 Cognitive Deficit/Impairment: g c d e f Cognitive Deficit/Impairment Comments:

Cardiac Disease: g c d e f Cardiac Disease Comments:

5

5

6

6

Fever: g c d e f Fever Comments:

Respiratory Disease: g c d e f Respiratory Disease Comments:

5

5

6

6

Albumin<35: g c d e f Albumin<35 Comments:

Surgery/Procedures: g c d e f Surgery/Procedures Comments:

5

5

6

6

Compromised Nutritional Status: g c d e f Compromised Nutritional Status Comments:

CVA: g c d e f CVA Comments:

5

5

6

6

Severe Infection: g c d e f Severe Infection Comments:

Skin Breakdown/Wound: g c d e f Skin Breakdown/Wound Comments:

5

5

6

6

Cancer: g c d e f Cancer Comments:

HIV: g c d e f HIV Comments:

6

GI Disorders/Diseases: g c d e f GI Disorders/Diseases Comments:

5

5

6

6

Diabetes: g c d e f Diabetes 5 Comments:

5

https://ont.nightingale.md/nic/patients/progressnote/ProgressNoteDataForm.asp?GETCLINI... 2/5/2013


Page 4 of 6

6 Hypercholesterolemia: g c d e f Hypercholesterolemia Comments:

6 Dehydration: g c d e f Dehydration Comments:

5

5

6

6

Hypertrigylceridemia: g c d e f

Renal Failure: g c d e f

Hypertrigylceridemia Comments:

Renal Failure Comments:

Hypertension: g c d e f Hypertension Comments:

5

5

6

6

Disordered Eating Patterns: g c d e f Disordered Eating Patterns Comments:

5

5

6

6

Vitamin/Mineral Deficiency: g c d e f Vitamin/Mineral Deficiency Comments:

Eating Disorder: g c d e f Eating Disorder Comments:

5

5

6

6

Iron deficiency (without anemia): g c d e f Iron deficiency (without anemia) Comments:

Bulimia Nervosa: g c d e f Bulimia Nervosa Comments:

5

5

6

6

Iron deficinecy (anemia): g c d e f Iron deficinecy (anemia) Comments:

GERD: g c d e f GERD Comments:

Anorexia Nervosa: g c d e f Anorexia Nervosa Comments:

5

5

6

6

Binge Eating Disorder: Binge 5Eating Disorder Comments:

c d e f g 5

https://ont.nightingale.md/nic/patients/progressnote/ProgressNoteDataForm.asp?GETCLINI... 2/5/2013


Page 5 of 6

5

6 Allergies: g c d e f Allergies Comments:

Obesity: g c d e f Obesity Comments:

6

5

5

6

6

Intolerances: g c d e f Intolerances Comments:

Other Comments:

5

5

6

6

Diabetes Care Education and Counseling

j Template View k l m i Narrative View n j k l m n Diabetes Education:

5

Diabetes Education Completed? Yes No

Diabetes Education Handouts Provided? Yes No

6 Nutrition Lipids Education:

Nutrition Lipids Education Completed? Yes No

5

Nutrition Lipids Handouts Provided? Yes No

6 Nutrition Diabetes Education:

Nutrtion Diabetes Education Completed? Yes No

Nutrition Diabetes Handouts Provided? Yes No

5

6

Foot Care Education Completed? Yes No

https://ont.nightingale.md/nic/patients/progressnote/ProgressNoteDataForm.asp?GETCLINI... 2/5/2013


Page 6 of 6

Follow Up Plan/to be discussed next time:

i Narrative View n j k l m n j Template View k l m

5

6

https://ont.nightingale.md/nic/patients/progressnote/ProgressNoteDataForm.asp?GETCLINI... 2/5/2013


Aohc diabetes education