Discovery Health Chronic Illness Benefit Form

Discovery Health Chronic Illness Benefit Form Patient Details: Name: Sarah Johnson Discovery Health Medical Scheme Number: 123456789 Date of Birth: 15/03/1980 ID Number: 8003154876087 Contact Number: 0721234567 Address: 123 Oak Avenue, Pretoria, 0001 Referring Doctor Details: Name: Dr. Emily White Practice Number: 0123456 Contact Number: 0125551234 Address: 456 Elm Street, Pretoria, 0002 Chronic Condition Details: Condition/Diagnosis: Type 2 Diabetes Mellitus Date of Diagnosis: 01/01/2020 ICD-10 Code: E11.9 Medication Prescribed: Medication 1: Metformin 500mg, twice daily Medication 2: Gliclazide 80mg, once daily Pathology Results (date of last test): Fasting Blood Glucose: 8.5 mmol/L (last tested 25/10/2024) HbA1c: 7.2% (last tested 25/10/2024) Lipid Profile: Within normal limits (last tested 25/10/2024) Creatinine: 75 umol/L (last tested 25/10/2024) Relevant Clinical History: Patient presented with classic symptoms of diabetes including polyuria, polydipsia, and unexplained weight loss. Initial diagnosis confirmed by elevated fasting blood glucose and HbA1c levels. Patient has a family history of Type 2 Diabetes. No known allergies. Patient is adherent to current medication regimen. Lifestyle modifications, including diet and exercise, have been initiated. Additional Comments/Recommendations: Regular monitoring of blood glucose levels is essential. Patient to continue with current medication and lifestyle interventions. Follow-up appointment scheduled in 3 months for review of blood glucose control and potential medication adjustments. Advised on diabetic foot care and the importance of regular ophthalmological checks. Referral to a dietitian has been provided. Date: 01 November 2024 Signature of Doctor: Dr. Emily White