Family Medicine Specialist Template
Clearwater T2DM Severity Assessment
A professional Family Medicine Specialist template for healthcare professionals.
About this template
Need a quick and easy way to assess your patients' diabetes severity? This Clearwater T2DM Severity Assessment template is perfect for Family Medicine Specialists. It helps you systematically evaluate key indicators like A1C, blood pressure, ASCVD risk, and more. This template, when used with Heidi, will automatically populate the fields based on your patient's visit transcript, saving you time and ensuring comprehensive documentation. Easily calculate a total severity score and classify the patient's condition for better management and care. Simplify your diabetes assessments today!
Preview template
Type 2 Diabetes Severity Assessment
Patient Information
John Smith
12/03/1960
1234567
01 November 2024
Assessment Criteria and Scoring
A1C
8.2
1
Blood Pressure
145/92
2
ASCVD Risk
12%
2
Waist Circumference
42 inches
3
BMI
32
2
Evidence of Fatty Liver Disease with AST/ALT lab scores
AST: 30
ALT: 35
2
Diabetic Foot Exam Score
1
1
eGFR
55
2
Last Retinal Exam
06/06/2023
2
On Medications
Metformin 1000mg twice daily, Lisinopril 20mg daily
3
Total Severity Score Calculation
Add all individual scores together.
Total calculated severity score: 18
Overall diabetes severity classification: Critical
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Step 2
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Step 3
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