Diabetes - Patient Clinical Tools

Diabetes


Diabetes Care Flow Sheet
Tool to be used by providers to track diabetes tests and care at each visit; sections include "History and Physical", "Laboratory Analysis", "Counseling and Risk Reduction", and setting "Self-Management Goals".
Source: NYCDOH
File Format: PDF

Diabetes Care Flow Sheet

NYCDOH Diabetes ABCs Chart Stickers
Stickers that can be placed in charts to track basic tests/evaluation for effective diabetes management. Source: NYCDOH
Print Instructions:
1. Print using standard size 2" X 4" labels
2. Go to Print
3. Select Color Printer
4. Page scaling- None
5. Print
File Format: PDF

Chart Stickers

Lower Extremity Amputation Prevention (LEAP)
LEAP is a comprehensive program that can dramatically reduce lower extremity amputations in individuals with diabetes mellitus, Hansen's disease, or any condition that results in the loss of protective sensation in the feet.
The LEAP website describes steps that can be taken to prevent lower extremity amputation and has instructions on how to use the LEAP monofilament. One can also order free microfilaments through the website.
Source: HRSA LEAP

LEAP website
Instructions on Diabetic Foot Screen for Loss of Protective Sensation Filament Application Instructions

Diabetes Foot Exam Tool Chart Sticker
Stickers that can be placed in charts to track foot exam results. Source: Prepared by IPRO under a contract with the Centers for Medicare & Medicaid Services (CMS) and the New York State Medicaid Program.
Print Instructions:
1. Print using standard size 2" X 4" labels
2. Go to Print
3. Select Color Printer
4. Page scaling- None
5. Print
File Format: PDF

Diabetes Foot Exam Tool Chart Sticker

Foot Exam Posters
Poster to be placed in exam room to serve as a reminder to conduct a foot exam.
Source: National Institutes of Health
File Format: PDF

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