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Get TX Blood Glucose Log 2005-2024

Ood Gluc /Dose . . Please mail to address listed above or send form via Fax to: (214) 456-5963 Phone H: (____)______-_______ W: ( Day of Month . Patient: Blood Glucose Log Month__________Year_____ Acct. No. Lunch Blood Gluc /Dose ) ______- ________ Dinner Blood Gluc /Dose Secure Fax (_____)______-_________ Bedtime Blood Gluc /Dose Patient/Parent Comments 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Endocrin.

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