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PART 1: VISIT CHECKLISTS

1. COMPONENTS OF THE INITIAL COMPREHENSIVE EVALUATION

 

The following is an initial clinic visit checklist for a newly diagnosed patient or a patient with pre-existing diabetes but not previously followed in your clinic. 

The initial evaluation should also include Ongoing Management Recommendations as part of a comprehensive evaluation.

 

Components of the Initial Comprehensive Evaluation of Adults with Type 2 Diabetes  
Diagnosis q  Review laboratory test related to the diagnosis of type 2 diabetes
Date of Diagnosis q  Record date of diagnosis in chart
History

q     Medical and family history

q     Assessment of lifestyle habits and activity level

q     Determine CVD co-morbidities: HTN, dyslipidemia, other CVD risk factors

q     Assess cultural and psychosocial issues

q     Assess social and economic resources

Screening and Assessments  

q     Depression screening

q     Tobacco use assessment

q     Evaluate TB status and place PPD if needed

Measurements

q     Height

q     Weight

q     Calculated BMI

q     Waist measurement

Comprehensive Physical Exam   Oral, thyroid palpation, cardiac, pulmonary, abdominal, pulses, extremities to include neurological foot check of sensation with 10 g monofilament
Labs/Tests  

q     HbA1c

q     Fasting lipid profile

q     ALT, AST, electrolytes, BUN, creatinine, calculated GFR

q     TSH (if indicated)

q     Urinary albumin, microalbuminuria/creatinine ratio

q     12-lead electrocardiogram

Medications  

q     Review previous treatments

q     Review current medications

Referrals  

q     Optometrist or ophthalmologist/retinal photo for eye exam

q     Registered dietitian (RD) or nutritionist 

q     Diabetes educator

q     Foot specialist if indicated

 

 

 

 

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