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pdf 5. Had there been any episodes of DKA?
1
Yes
Required ED visit
2 Required hospitalization
2
3
1
No
Not indicated
6. Had diabetes education occurred?
6a. Diabetes nurse education:
Yes
2 No
3 Not indicated
1
6b. Nutritionist:
Yes
2 No
3 Not indicated
1
6c. Social worker or psychologist:
Yes
2 No
3 Not indicated
1
FOR STUDY USE ONLY
Date Completed
Completed by
Month
Day
Year
Date Reviewed
Reviewer Code
Month
Day
Year
Date Entered
Month
Day
Year
Data Entry
Code
SEARCH 3 Cohort Study Medical Record Validation of Self Report Form 9-13-10
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| File Type | application/pdf |
| File Title | Microsoft Word - index |
| Author | stmoxley |
| File Modified | 2011-05-10 |
| File Created | 2010-11-08 |