Duration of DM (yrs):
Last A1C (value & date): ___
DM Medications: ___
Compliance with medications?:___
Compliance with diet, exercise?:____
History of hypoglycemia: None
Hx of MI, CVA, PAD: ___
Last dilated retinal exam:__
Last diabetic foot exam:__
Patient:
Denies polyuria, polydipsia, polyphagia, fatigue, weight loss, poor wound healing.
Denies symptoms of retinopathy like blurry vision.
Denies symptoms of peripheral neuropathy (numbness, tingling, feet with pins/needles, feet on fire).
Denies knowledge of a history of nephropathy or kidney problems.
Denies symptoms of diabetic esophageal dysmotility.
Denies symptoms or history of GI disorders that are common complications of DM like gastroparesis, nonalcoholic fatty liver disease, GERD, and intestinal enteropathy (including chronic diarrhea, constipation, and fecal incontinence.)
Denies any cuts or wounds on the feet.
Last ophthalmology visit was less than a year ago. The patient is going to set up an appointment with an ophthalmologist when the time comes for the next exam.