Diabetes Data Collection Tools & Forms - International Diabetes Center

From the initial patient history through all stages of planning and treatment, these forms give you everything you need to gather essential data. For use, ideally, with the BASICS diabetes education curriculum, these forms have been designed and tested in working clinics.

Item #

Image

Description

Price

2058-HIST

Adult Diabetes History Form

The Adult Diabetes History Form allows the educator to collect demographic and health history information prior to the first BASICS session. This allows for an initial overview of each client's status and for later data analysis by demographic factors. Also included in Type 2 and Insulin Outcome Kits. 2008. Sold in packs of 50.

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2058-GHIS

Gestational Diabetes History Form

This standardized form is used to collect demographic and health history information from patients, including data related to prior pregnancies. 2010. Package of 50.

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2058-FLOW

Adult Diabetes Flow Sheet

See progress at a glance when you document education and clinical data all in one place. Also included in Type 2 and Insulin Outcome Kits. 2008. Four pages. Package of 50.

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2058-GLOW

Gestational Diabetes Flow Sheet

This form is a comprehensive tool used by educators at each session to track patient progress, document educational content and process, and collect clinical data. Information collected provides the basis for charting, communicating with providers, and analyzing clinical outcomes. 2011. Package of 50.

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2058-MPGA

Diabetes Success Plan

Take the groans out of goal setting. This easy-to-use tool provides instructions on the back side, goal options and motivational interviewing techniques to facilitate goal setting. It allows patients to set a goal using one of the seven AADE self-care categories. Helps track even small improvements and document them for ADA program recognition. 2009. Package of 10.

Special Pricing Available

In Stock

2058-FTAB

Food & Activity Record Tablet

Simple and inexpensive, these tear-off sheets help patients provide you with the data you need. Designed for use with BASICS curricula, but they’re also popular as stand-alone recordkeeping tools. 2004. 80 sheets.

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2058-SURV

Client Satisfaction Survey Tablet

Find out how your patients think you're doing by capturing objective and subjective data about your program and about their feelings of control over diabetes. Also included in Outcome Kits. 2008. 80 sheets.

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2058-GSURV

Gestational Diabetes Patient Satisfaction Survey

This new patient survey allows educators to easily gather objective and subjective data about their gestational diabetes education program. When used with other data collection tools, it helps educators assess whether the curriculum needs to be adapted to better serve their patient population. 2011. Package of 50.

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2058-TEST

Type 2 Diabetes BASICS Knowledge Test

Reliable and valid tool for measuring patient knowledge. Also included in the Type 2 Diabetes BASICS Outcomes Kit. Second edition. 2004. Package of 50.

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2058-INKT

Insulin BASICS Knowledge Test

This test offers valid and reliable data for assessing client learning. Topic areas include general knowledge, insulin skills, nutrition, blood glucose monitoring, and psychosocial issues. 2008. Package of 50.

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2058-OUTS

Type 2 Diabetes BASICS Outcome Kit

BASICS outcomes data collection tools are all that's needed to collect and document important outcomes data while teaching. Save hours of searching for charts and documenting after-the-fact. Each kit contains forms to guide 10 patients through an entire program.

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2058-IOUT

Insulin BASICS Outcome Kit

BASICS outcomes data collection tools are all that's needed to collect and document important outcomes data while teaching. Save hours of searching for charts and documenting after-the-fact. The Insulin Diabetes BASICS curriculum guide includes directions for incorporating documentation tools into your program.

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2058-ITAB

My Insulin Plan Tablet

Communicate insulin dose changes to patients and provide a ready reminder of measuring technique with this two-sided handout. Provides space for noting insulin dose and carbohydrate intake, plus testing, injection and meal times. Includes target blood glucose numbers on the front of the form. 2008. 80 sheets per tablet.

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