Get Chicago Southeast Diabetes Long Version Questionnaire Healthcare Form

Completing the Chicago Southeast Diabetes Long Version Questionnaire Healthcare Form online can help facilitate accurate assessment of your diabetes self-care activities. This guide provides clear, step-by-step instructions to assist users in filling out the form effectively.

Follow the steps to complete your questionnaire accurately.

1. Select the ‘Get Form’ button to access the questionnaire and open it in the online editor.
2. Begin by filling out your name at the top of the form. Ensure all relevant personal information is entered correctly, to facilitate future communications.
3. Indicate the test type by selecting either ‘Pre-Test,’ ‘Post-Test,’ or ‘Follow-up’ in the designated section. This helps categorize your responses properly.
4. Provide the date of completion in the specified field. This is crucial for tracking your progress over time.
5. For the Diet section, respond to questions 1 to 5 by circling the number of days you engaged in each activity over the past 7 days. Be honest and reflective to give accurate data.
6. In the Exercise section, respond to questions 6 and 7 similarly, detailing your physical activity participation during the past week.
7. For Blood Sugar Testing and Foot Care, answer questions 8 to 11, circling the appropriate number of days for blood sugar testing, foot checks, and shoe inspections.
8. Fill out the Medication section by answering questions 12 to 14 regarding your medication adherence over the last 7 days.
9. Finally, in the Smoking section, answer question 15 and, if applicable, question 16 about your smoking habits.
10. Before submitting, review all your responses thoroughly to ensure accuracy. Once satisfied, save your changes, download, print, or share the form as needed.

Take the next step in managing your diabetes by completing the Chicago Southeast Diabetes Long Version Questionnaire online today.