Discovery Health PMB Form

Specialty: General Practitioner **Discovery PMB Form** **Patient Information:** * **Name:** John Smith * **Discovery Medical Aid Number:** 123456789 * **Date of Birth:** 15/03/1980 * **Contact Number:** 072 123 4567 * **Email:** john.smith@example.com **Referring Doctor Information:** * **Name:** Dr. Emily White * **Practice Number:** 0123456 * **Contact Number:** 021 555 1234 **Condition Details:** * **Condition:** Type 2 Diabetes Mellitus * **ICD-10 Code:** E11.9 * **Date of Diagnosis:** 01/01/2020 * **Brief Medical History:** Mr. Smith has a 4-year history of Type 2 Diabetes, currently managed with Metformin. He also has well-controlled hypertension. No known allergies. Family history of diabetes. He reports occasional blurred vision and fatigue. Recent HbA1c was 8.2%. **Treatment Plan:** * **Proposed Treatment:** Intensification of diabetes management, including consideration of SGLT2 inhibitor or GLP-1 receptor agonist, dietary review with a dietician, and increased physical activity. Regular blood glucose monitoring. Ophthalmology referral for retinal screening. Podiatry referral for foot care. **Motivation for PMB (Prescribed Minimum Benefits) Application:** * **Clinical Justification:** Type 2 Diabetes Mellitus is a chronic condition that falls under Prescribed Minimum Benefits (PMB). The current glycemic control is sub-optimal (HbA1c 8.2%), necessitating a more aggressive treatment strategy to prevent long-term complications. The proposed treatment plan adheres to evidence-based guidelines for diabetes management and aims to improve patient outcomes and quality of life. * **Expected Outcomes:** Improved glycemic control (target HbA1c <7%), reduction in risk of macrovascular and microvascular complications, enhanced patient education and self-management, and overall better health status. **Declaration:** I, Dr. Emily White, declare that the information provided above is accurate and true to the best of my knowledge. **Date:** 01 November 2024 **Signature:** [Electronically signed by Dr. Emily White]