97 1 ASSESSMENT 22 2 30 55 2 0 0 112 ASSESSMENT OF DIABETES CARE, 2009 AUDITDATE 3 5 30 15 5 2 10 112 AUDIT DATE: FACILITYNA 3 7 30 18 7 3 20 112 FACILITY NAME: AREA 3 9 30 9 9 1 2 112 AREA: SU 16 9 30 30 9 1 2 112 SERVICE UNIT: FACILITY 38 9 30 48 9 1 2 112 FACILITY: REGNUM 3 11 30 49 11 6 5 112 NUMBER OF ACTIVE DM PTS IN REGISTRY: REGNUM SDPIGRANT 3 13 30 40 13 0 1 112 COMMUNITY RECEIVES SDPI GRANT FUNDS? GRANTNUM 3 14 30 22 14 3 11 112 SDPI GRANT NUMBER: REVIEWER 3 16 30 13 16 3 3 112 REVIEWER: TRIBAL 3 18 30 17 18 1 3 112 TRIBAL AFFIL: STATE 3 20 30 23 20 3 2 112 STATE OF RESIDENCE: CHARTNUM 3 22 30 17 22 6 6 112 CHART NUMBER: DOB 3 26 30 18 26 2 10 112 DATE OF BIRTH: AGE 3 28 30 29 28 0 3 112 Calculated AGE at Review: SEX 3 31 30 8 31 0 1 112 SEX: DODX 3 34 30 37 34 2 10 112 DATE OF DIAGNOSIS OF DM: DODX DURDM 3 36 30 19 36 0 2 112 DURATION OF DM: DMTYPE 3 39 30 28 39 0 1 112 DIABETES TYPE: DMTYPE TOBACCO 3 42 30 16 42 0 1 112 TOBACCO USE: TOBCOUNSEL 3 44 30 32 44 0 1 112 TOBAC. CESSATION COUNSELING: FEET 3 48 30 38 48 0 1 112 HEIGHT: FEET INCHES 42 48 30 49 48 102 5 112 INCHES HEIGHT 5 49 30 40 49 102 5 112 Calculated in inches: HEIGHT WEIGHT 3 51 30 31 51 0 3 112 MOST RECENT WEIGHT (LBS): BMI 5 52 30 21 52 101 4 112 Calculated BMI: HTNDXTX 3 55 30 41 55 0 1 112 HYPERTENSION DX'ED OR TX'ED IN CHART: SYST1 3 57 30 34 57 0 3 112 LAST 3 BLOOD PRESSURES: SYST1 DIAST1 40 57 30 47 57 0 3 112 DIAST1 SYST2 28 58 30 34 58 0 3 112 SYST2 DIAST2 40 58 30 47 58 0 3 112 DIAST2 SYST3 28 59 30 34 59 0 3 112 SYST3 DIAST3 40 59 30 47 59 0 3 112 DIAST3 SYSMEAN 4 61 30 30 61 0 3 112 Calculated SYSTOLIC MEAN: DIAMEAN 39 61 30 55 61 0 3 112 DIASTOLIC MEAN: EXAMINATIO 27 64 30 39 64 0 0 112 EXAMINATIONS FOOTEXAM 3 66 30 14 66 0 1 112 FOOT EXAM: EYEEXAM 3 67 30 13 67 0 1 112 EYE EXAM: DENTALEXAM 3 68 30 16 68 0 1 112 DENTAL EXAM: EDUCATION 27 70 30 36 70 0 0 112 EDUCATION DIETINSTR 3 72 30 34 72 0 1 112 DIET INSTRUCTION IN PAST YEAR: EXERCISE 3 73 30 38 73 0 1 112 EXERCISE INSTRUCTION IN PAST YEAR: DMEDUC 3 74 30 36 74 0 1 112 OTHER DM EDUCATION IN PAST YEAR: DMTHERAPY1 8 76 30 39 76 0 0 112 DM THERAPY 1=YES 2=NO TXDIET 3 78 30 35 78 0 1 112 1 DIET CONTROL ONLY: TXDIET TXINSUL 3 79 30 36 79 0 1 112 2 INSULIN: TXINSUL TXSUREA 3 80 30 36 80 0 1 112 3 SULFONYLUREA: TXSUREA TXMETFORM 3 81 30 38 81 0 1 112 4 METFORMIN: TXMETFORM TXACAR 3 82 30 35 82 0 1 112 5 ACARBOSE: TXACAR TXGLIT 3 83 30 35 83 0 1 112 6 GLITAZONE: TXGLIT TXBYETTA 3 84 30 37 84 0 1 112 7 INCRETIN MIMETICS: TXBYETTA TXDPP4 3 85 30 35 85 0 1 112 8 DPP4 INHIBITORS: TXDPP4 TXAMYLIN 3 86 30 37 86 0 1 112 9 AMYLIN ANALOGUES: TXAMYLIN TXREFUNK 2 87 30 37 87 0 1 112 10 REFUSED/UNKNOWN: TXREFUNK ACE 3 89 30 26 89 0 1 112 ACE INHIBITOR/ARB USE: ASPIRIN 3 90 30 29 90 0 1 112 ASPIRIN/ANTIPLATELET USE: LIPIDAGENT 3 91 30 29 91 0 1 112 LIPID LOWERING AGENT USE: IMMUNIZATI 27 94 30 40 94 0 0 112 IMMUNIZATIONS FLUVAX 3 96 30 35 96 0 1 112 FLU VACCINE CURRENT: FLUVAX PNEUMOVAX 3 97 30 38 97 0 1 112 PNEUMOVAX EVER: PNEUMOVAX TD 3 98 30 31 98 0 1 112 TD IN PAST 10 YEARS: TD PPD 3 102 30 15 102 0 1 112 PPD STATUS: INHTXCOM 4 104 30 60 104 0 1 112 IF PPD POSITIVE, WAS INH TREATMENT COMPLETE: INHTXCOM PPDDATE 4 105 30 60 105 2 10 112 IF PPD NEGATIVE, DATE OF LAST NEGATIVE PPD: PPDDATE TBSTATUS 3 107 30 26 107 0 1 112 Calculated TB STATUS: EKGDONE 3 111 30 22 111 0 1 112 EKG EVER: EKGDONE EKGDATE 3 113 30 37 113 2 10 112 DATE OF MOST RECENT EKG: EKGDATE LABORATORY 27 116 30 43 116 0 0 112 LABORATORY TESTS HBA1C 3 118 30 22 118 101 4 112 MOST RECENT HBA1C: HBA1CDATE 32 118 30 55 118 2 10 112 DATE DRAWN: HBA1CDATE CREATDONE 3 121 30 46 121 0 1 112 CREATININE IN PAST YEAR: CREATDONE CREATVALUE 6 122 30 47 122 101 4 112 LAST CREATININE VALUE: CREATVALUE EGFR 3 124 30 69 124 0 1 112 ESTIMATED GFR DOCUMENTED IN MED RECORD DURING AUDIT PERIOD? EGFR EGFRVALUE 3 125 30 25 125 101 5 112 ESTIMATED eGFR VALUE: CHOLDONE 3 127 30 45 127 0 1 112 TOTAL CHOLESTEROL IN PAST YEAR: CHOLDONE CHOLVALUE 6 128 30 46 128 0 3 112 LAST TOTAL CHOLESTEROL VALUE: CHOLVALUE HDLDONE 3 130 30 44 130 0 1 112 HDL CHOLESTEROL IN PAST YEAR: HDLDONE HDLVALUE 6 131 30 45 131 0 3 112 LAST HDL CHOLESTEROL VALUE: HDLVALUE LDLDONE 3 133 30 44 133 0 1 112 LDL CHOLESTEROL IN PAST YEAR: LDLDONE LDLVALUE 6 134 30 45 134 0 3 112 LAST LDL CHOLESTEROL VALUE: LDLVALUE TRIGDONE 3 136 30 45 136 0 1 112 TRIGLYCERIDE IN PAST YEAR: TRIGDONE TRIGVALUE 6 137 30 47 137 0 4 112 LAST TRIGLYCERIDE VALUE: TRIGVALUE: URINEPROTE 3 141 30 24 141 0 0 112 URINE PROTEIN TESTING UPTESTDONE 6 142 30 55 142 0 1 112 DURING 12 MO AUDIT PERIOD?: UPTESTDONE UPTESTTYPE 3 144 30 55 144 0 1 112 TYPE OF URINE PROTEIN TESTING: UPTESTTYPE N1QUANTITA 6 145 30 45 145 0 0 112 1=Quantitative albumin:creatinine ratio UPACRQVAL 12 146 30 51 146 101 8 112 UACR VALUE (IN MG/G): UPACRQVAL N2SEMIQUAN 6 147 30 49 147 0 0 112 2=Semiquantitative albumin:creatinine ratio UPACRSQCAT 12 148 30 60 148 0 1 112 SEMIQUANT UACR CATEGORY (1,2 OR 3) UPACRSQCAT N3PROTEINC 6 149 30 32 149 0 0 112 3=Protein:creatinine ratio N4OTHERQUA 6 150 30 67 150 0 0 112 4=Other quantitative urine protein test (e.g., 24 hr albumin) N5FOUNDHAV 6 151 30 66 151 0 0 112 5=Found to have 1+protein or greater on standard UA dipstick N6OTHERNON 6 152 30 35 152 0 0 112 6=Other non-quantitative test DEPDX 3 155 30 59 155 0 1 112 DOES PT HAVE DEPRESSION AS AN ACTIVE DIAGNOSIS? DEPDX DEPSCREEN 3 156 30 65 156 0 1 112 SCREENED FOR DEPRESSION DURING 12 MO AUDIT PERIOD? DEPSCREEN LOCAL 3 158 30 34 158 0 1 112 LOCAL OPTION QUESTION: LOCAL SOURCESYS 3 160 30 51 160 3 10 112 AUDIT TYPE (MANUAL VS ELECTRONIC): SOURCESYS