Health Evaluation and Test Records

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This simple tool can be used to record the types of services, tests and their results to help you or your loved one manage their diabetes care. There is also room to record any vaccines you or your loved may have received, including the results from those vaccines. Remember to take this record to your doctor appointments, so your doctor can make sure you are up to date with your tests and vaccines.

Health Evaluation Test Records PDF
Health Evaluation Test Records Spanish PDF

Disclaimer: The information about educational or therapeutic approaches is provided for educational purposes only. Certain treatments may or may not be covered through your benefit plan. Coverage typically depends on your plan specifications and relevant guidelines maintained in relation to your benefit plan.

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