Get Medication Review Form For Patient With Diabetes - Panl

Completing the Medication Review Form for Patient With Diabetes online is an essential step towards effective diabetes management. This guide provides clear instructions to help you navigate each section of the form, ensuring you provide all necessary information accurately.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the patient information. Fill out the last name, first name and initial, gender, and date of birth in the specified fields.
3. Next, document any known medication allergies or reactions. For each drug name, specify the related reaction in the corresponding fields.
4. Provide the MCP number of the patient, along with family physician information including their name, phone number, and fax number. Indicate whether the physician has been contacted.
5. List all known medical conditions in the designated section. Check 'Yes' or 'No' for tobacco and alcohol use, adding any relevant details.
6. In the patient consent information section, mark whether consent was given by the patient or a representative, and provide the representative's name if applicable.
7. Record the patient's physical activity levels, and prepare the Best Possible Medication List. For each medication, include the drug name, dosage, and reason for use.
8. Proceed to the diabetes monitoring section. Indicate the type of diabetes diagnosed, the age at diagnosis, and whether the patient checks their blood sugar regularly.
9. Fill in the last known blood glucose level, HbA1C level, blood pressure reading, and LDL-C level. If available, also include TC/HDL-C level.
10. Provide pharmacist notes and recommendations regarding diabetes monitoring, and check off the activities performed during the consultation.
11. Finally, complete the pharmacy information, patient or representative signature, and pharmacist details including name, signature, phone number, fax number, and date prepared.
12. Review the entire form for accuracy, then save changes, download, print, or share the completed form as needed.

Complete your documents online to ensure timely and effective management of diabetes.