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Get Dexcom LBL-011698 2004

SITY # Multiple Daily Injections per day On pump? HbA1c: Fasting Hyperglycemia mg/dl DOB: Address City/St/Zip # SMBG/day Start Date: Date: Date: 365/365 (1 unit = 1 day) Directions for use: Site change per manufacturer recommendation, up to 90 day supply unless otherwise noted to per day Fluctuation of blood glucose values: Between mg/dl and mg/dl Currently on CGM Therapy? Dx Code Specific to Complications Associated with Diabetes: ICD-9 Code: ICD-9 Code: Current Diabetic Complic.

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