DIABETES AND YOU
THE DIABETES STORE CLASSES
Give this form to your healthcare provider to fill out. It will need to be submitted to the Diabetes Store for processing.
Patient Prescription Form
Patient Data Sheet
This form is used for contact information, emergency contact information, and insurance information.
Patient Service Agreement
This form is your Authorization/Consent for Service/Care.
We take privacy very serious. Please sign this HIPAA Agreement, acknowledging receipt of our policy.
Patient Bill of Rights
For information on your rights as a patient, please refer to this form.
Making decisions can be difficult when dealing with new information. This sheet may help with making decisions regarding your healthcare.
Make Your Home Safe
This form will provide information and tips to make your home safe when medical care is needed.
It is important to think about all situations that may happen, expecially when a family member is under medical treatment. This sheet will give you information and tips on planning ahead for dealing with an emergency.
The Diabetes Store is required to comply with standards required by the Center for Medicare and Medicaid Services. This form is provided to you for your information only. No signature is required.
Patient Information Packet
We've combined all forms into one document for your convenience. You can print the packet and keep for your records.