101 1 ASSESSMENT 22 1 30 55 1 0 0 112 ASSESSMENT OF DIABETES CARE, 2005 AUDITDATE 2 3 30 14 3 2 10 112 AUDIT DATE: FACILITYNA 30 3 30 45 3 3 20 112 FACILITY NAME: AREA 2 5 30 8 5 1 2 112 AREA: SU 13 5 30 27 5 1 2 112 SERVICE UNIT: FACILITY 35 5 30 45 5 1 2 112 FACILITY: REGNUM 2 7 30 48 7 6 5 112 NUMBER OF ACTIVE DM PTS IN REGISTRY: REGNUM SDPIGRANT 2 9 30 39 9 0 1 112 COMMUNITY RECEIVES SDPI GRANT FUNDS? GRANTNUM 45 9 30 64 9 3 11 112 SDPI GRANT NUMBER: TRIBAL 2 11 30 16 11 1 3 112 TRIBAL AFFIL: COMM 25 11 30 36 11 1 7 112 COMMUNITY: REVIEWER 48 11 30 58 11 3 3 112 REVIEWER: CHARTNUM 2 13 30 25 13 6 6 112 CHART NUMBER: CHARTNUM DOB 2 15 30 21 15 2 10 112 DATE OF BIRTH: DOB AGE 37 15 30 67 15 0 3 112 Calculated AGE at Review: AGE SEX 2 16 30 7 16 0 1 112 SEX: DODX 2 18 30 38 18 2 10 112 DATE OF DIAGNOSIS OF DM: DODX DURDM 54 18 30 76 18 0 2 112 DURATION OF DM: DURDM DMTYPE 2 20 30 39 20 0 1 112 DIABETES TYPE: DMTYPE TOBACCO 2 22 30 40 22 0 1 112 TOBACCO USE: TOBACCO COUNSEL 2 23 30 40 23 0 1 112 TOBAC. CESSATION COUNSELING: COUNSEL FEET 2 24 30 37 24 0 1 112 HEIGHT: FEET INCHES 41 24 30 48 24 102 5 112 INCHES HEIGHT 4 25 30 39 25 102 5 112 Calculated in inches: HEIGHT WEIGHT 2 26 30 39 26 0 3 112 MOST RECENT WEIGHT (LBS): WEIGHT BMI 4 27 30 36 27 101 4 112 Calculated BMI: BMI CHARTHTN 2 29 30 49 29 0 1 112 HYPERTENSION DX'ED OR TX'ED IN CHART: CHARTHTN SYST1 2 31 30 33 31 0 3 112 LAST 3 BLOOD PRESSURES: SYST1 DIAST1 39 31 30 46 31 0 3 112 DIAST1 SYST2 27 32 30 33 32 0 3 112 SYST2 DIAST2 39 32 30 46 32 0 3 112 DIAST2 SYST3 27 33 30 33 33 0 3 112 SYST3 DIAST3 39 33 30 46 33 0 3 112 DIAST3 SYSMEAN 4 34 30 38 34 0 3 112 Calculated SYSTOLIC MEAN: SYSMEAN DIAMEAN 44 34 30 68 34 0 3 112 DIASTOLIC MEAN: DIAMEAN EXAMINATIO 27 36 30 39 36 0 0 112 EXAMINATIONS FOOTEXAM 2 38 30 31 38 0 1 112 FOOT EXAM: FOOTEXAM EYEEXAM 2 39 30 30 39 0 1 112 EYE EXAM: EYEEXAM DENTALEXAM 2 40 30 33 40 0 1 112 DENTAL EXAM: DENTALEXAM EDUCATION 27 42 30 36 42 0 0 112 EDUCATION DIETINSTR 2 44 30 47 44 0 1 112 DIET INSTRUCTION IN PAST YEAR: DIETINSTR EXERCISE 2 45 30 46 45 0 1 112 EXERCISE INSTRUCTION IN PAST YEAR: EXERCISE DMEDUC 2 46 30 44 46 0 1 112 OTHER DM EDUCATION IN PAST YEAR: DMEDUC THERAPY 27 47 30 34 47 0 0 112 THERAPY TXCODE 2 49 30 18 49 0 4 112 THERAPY: TXCODE TXNAME 29 49 30 37 49 3 16 112 TXNAME: ACE 2 50 30 33 50 0 1 112 ACE INHIBITOR/ARB USE: ACE ASPIRIN 2 51 30 37 51 0 1 112 ASPIRIN/ANTIPLATELET USE: ASPIRIN LIPIDAGENT 2 52 30 40 52 0 1 112 LIPID LOWERING AGENT USE: LIPIDAGENT IMMUNIZATI 27 54 30 40 54 0 0 112 IMMUNIZATIONS FLUVAX 2 56 30 35 56 0 1 112 FLU VACCINE CURRENT: FLU VAX PNEUMOVAX 2 57 30 37 57 0 1 112 PNEUMOVAX EVER: PNEUMOVAX TD 2 58 30 30 58 0 1 112 TD IN PAST 10 YEARS: TD PPD 2 61 30 31 61 0 1 112 PPD STATUS: PPD INHTXCOM 3 62 30 60 62 0 1 112 IF PPD POSITIVE, WAS INH TREATMENT COMPLETE: INHTXCOM PPDDATE 3 63 30 60 63 2 10 112 IF PPD NEGATIVE, DATE OF LAST NEGATIVE PPD: PPDDATE TBSTATUS 3 64 30 37 64 0 1 112 Calculated: TB STATUS: TBSTATUS EKG 2 67 30 17 67 0 1 112 EKG EVER: EKG EKGDATE 24 67 30 58 67 2 10 112 DATE OF MOST RECENT EKG: EKGDATE LABORATORY 27 71 30 43 71 0 0 112 LABORATORY TESTS HBA1C 2 73 30 34 73 101 4 112 MOST RECENT HbA1c: HBA1C A1CDATE 43 73 30 58 73 2 10 112 DATE: A1CDATE HBA1C2 2 75 30 34 75 101 4 112 NEXT MOST RECENT HbA1c: HBA1C2 CREATIN 2 77 30 43 77 0 1 112 CREATININE IN PAST YEAR: CREATIN CREATVALUE 5 78 30 46 78 101 4 112 LAST CREATININE VALUE: CREATVALUE CHOLDONE 2 80 30 44 80 0 1 112 TOTAL CHOLESTEROL IN PAST YEAR: CHOLDONE CHOLVALUE 5 81 30 45 81 0 3 112 LAST TOTAL CHOLESTEROL VALUE: CHOLVALUE HDLDONE 2 83 30 43 83 0 1 112 HDL CHOLESTEROL IN PAST YEAR: HDLDONE HDLVALUE 5 84 30 44 84 0 3 112 LAST HDL CHOLESTEROL VALUE: HDLVALUE LDLDONE 2 86 30 43 86 0 1 112 LDL CHOLESTEROL IN PAST YEAR: LDLDONE LDLVALUE 5 87 30 44 87 0 3 112 LAST LDL CHOLESTEROL VALUE: LDLVALUE TRIGDONE 2 89 30 44 89 0 1 112 TRIGLYCERIDE IN PAST YEAR: TRIGDONE TRIGVALUE 5 90 30 46 90 0 4 112 LAST TRIGLYCERIDE VALUE: TRIGVALUE: UA 2 94 30 49 94 0 1 112 URINALYSIS OR A/C RATIO IN PAST YEAR: UA PROTEINURI 5 95 30 43 95 0 1 112 PROTEINURIA PRESENT: PROTEINURI MICROALB 5 96 30 41 96 0 1 112 MICROALBUMINURIA PRESENT: MICROALB MONITORING 27 99 30 37 99 0 0 112 MONITORING SMBG 2 101 30 50 101 0 1 112 SELF BLOOD GLUCOSE MONITORING DOCUMENTED: SMBG SUPPLEMENT 27 104 30 47 104 0 0 112 SUPPLEMENTAL SECTION DEPDX 2 106 30 58 106 0 1 112 DOES PT HAVE DEPRESSION AS AN ACTIVE DIAGNOSIS? DEPDX DEPSCREEN 4 107 30 73 107 0 1 112 IF NOT, HAS PT BEEN SCREENED FOR DEPRESSION IN PAST YEAR? DEPSCREEN LOCALOPTIO 28 110 30 48 110 0 0 112 LOCAL OPTION SECTION EPIC 2 112 30 41 112 0 1 112 ATTENDED EPIC: EPIC FAMTHER 2 114 30 44 114 0 1 112 SESSION W FAMILY THERAPIST: FAMTHER ATTENDEDOT 2 117 30 52 117 0 0 112 ATTENDED OTHER DIABETES SELF-MANAGEMENT EDUCATION: DMHTN 5 119 30 43 119 0 1 112 DIABETES AND HTN CLASS: DMHTN LOWLIPID 5 120 30 46 120 0 1 112 LOWERING LIPIDS CLASS: LOWLIPID MNT 5 122 30 41 122 0 1 112 MEDICAL NUTRITION THERAPY - RD: MNT WTMANAG 5 123 30 45 123 0 1 112 WEIGHT MANAGEMENT SESSION: WTMANAG MCNANNUALC 2 126 30 17 126 0 0 112 MCN ANNUAL CARE YRLYCLINIC 5 128 30 52 128 0 1 112 ATTENDED YEARLY CLINIC: YRLYCLINIC FOLLOWUP 5 130 30 50 130 0 1 112 FOLLOWUP YEARLY CLINIC: FOLLOWUP MCNROUTINE 2 133 30 18 133 0 0 112 MCN ROUTINE CARE A1CAVAIL 5 135 30 50 135 0 1 112 HBA1C AVAILABLE AT PT ENCOUNTER: A1CAVAIL SBGMREPORT 5 137 30 52 137 0 1 112 COMPUTERIZED SBGM REPORT AVAILABLE: SBGMREPORT FOOTCARE 2 140 30 11 140 0 0 112 FOOT CARE FOOTSTAGE 4 142 30 52 142 0 1 112 FOOT RISK STAGE PER THIS YR'S EXAM: FOOTSTAGE STAGE2ORMO 4 144 30 23 144 0 0 112 IF STAGE 2 OR MORE, SHOEREF 7 145 30 50 145 0 1 112 SHOE REFERRAL IN CHART: SHOEREF SHOESATIS 7 146 30 52 146 0 1 112 PT SATISFIED WITH SHOES: SHOESATIS SMOKECESS 2 148 30 52 148 0 1 112 SMOKING CESSATION CLASS: SMOKECESS