Like the General Patient Care Advisory, the Diabetic Patient Care Advisory keeps your patients' other doctors advised of treatment you are giving the patient. It's easy for you to fill out and for other doctors to understand quickly.The Diabetic Patient Care Advisory makes the patient’s other doctors aware of the thoroughness of the exam that you provide to the diabetic at-risk patient.

This form establishes you as the expert in diagnosing, treating and most importantly managing the special needs of the diabetic patient and the extra risks associated with their condition. You’ll be the one they want to refer their other patients to because they don’t have the time or expertise to manage the lower extremities of the diabetic patient the way you do.

It opens the discussion about your diabetic shoe program giving you the opportunity to inform the primary care physician when it is appropriate to prescribe the diabetic shoes that you can dispense to their patients.

This is a two-part NCR carbonless designed so the original gets mailed to the primary care physician and a duplicate copy is automatically generated for your charts and has an area to document special mailing instructions for your staff as well as an area to document your follow-up.


Financial - Insurance
Patient History
Physical Exam
Podiatric Services Report
Skin & Nailcare follow-up
Nursing Home
Large Podiatry Referral
Pocket Podiatry Referral
General SOAP
General Care Advisory
Diabetic Care Advisory
Radiography Report
Lower Leg Wound Care Report