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INFOCore Diabetes Report
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| Name: |
Sample Patient |
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| ID: |
123456789 |
Gender: |
Female
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| Date: |
9/30/2003 1:25:07 PM |
Age: |
54 |
Symptoms over last month
| Excessive thirst and urination | Often |
| Muscular strength and endurance | Rather poor |
| Blurring of vision | Sometimes |
| Exercise without low blood sugar | A fair amount |
| Energy | Quite low |
| Sleep | Slept not very well |
| Constipation | A little of the time |
| Burning, tingling, pain, numbness | Mild |
| Able to function sexually | Sometimes |
| Vomit after eating | Rarely |
| Faint, dizzy on sitting or standing | Rarely |
| Appetite been good | Usually |
| Abdominal discomfort after eating | Usually |
| Lacking enough energy | Sometimes |
| Diarrhea | Rarely |
| Nauseated after eating | Often |
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Composite Scores
| Understand Mgt | 86 |
| Support Needs | 67 |
| Support Received | 73 |
| Control Problems | 78 |
| Well-Being | 42 |
| Moral | 61 |
| Social | 43 |
| Positive Attitude | 80 |
| Negative Attitude | 80 |
| Care Ability | 95 |
| Importance of Care | 95 |
| Self-Care Adherence | 85 |
| Diet Adherence | 90 |
| Long-Term Benefit | 92 |
| Exercise Barriers | 88 |
| Monitoring Barriers | 85 |
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Yes
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Test sugar
: 5days/wk, 4times/day
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No
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Smoker |
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< 6 mon
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Vision Exam |
< 6 mon
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Dental Exam |
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No
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Prescription Drugs |
No
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Prescribed but stopped |
| Family History:
Heart trouble, High cholesterol
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| Medical Conditions:
Arthritis/Rheumatism, Seizures or epilepsy, PMS, Frequent cold or flu
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__________________________________________
Provider
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