EXAMPLE
Date
Sally Smith
123 Main Street
Anytown, USA
Dear Ms. Smith:
It is important to work together to make sure we do everything possible to control your diabetes. There are
useful tests you can do that give us information we can use to help avoid or slow the complications associated
with diabetes. My records indicate that you are due for the following:
Hemoglobin A1c Test: This test measures the average level of sugar in your blood over a 2 to 3 month
period. To make sure that your blood sugar is under control, you should have a hemoglobin A1c test
done at least twice a year.
Dilated Retinal Eye Exam: Diabetes may cause damage to the back of your eyes (the retina). Early
detection and treatment can help to prevent loss of vision and blindness. This exam requires dilation of
the eyes and is different from more traditional eye exams you may have had to check your vision or
update your eyeglasses. Most people with diabetes should have a dilated retinal eye exam once a year.
Microalbuminuria Test: Diabetes may cause damage to your kidneys. Early detection and treatment
of kidney problems can help to manage this complication. The microalbuminuria test helps monitor
your kidney function by measuring the amount of protein in your urine. Most people with diabetes
should have a microalbuminuria test performed once a year unless they are already on medication for
this problem.
Low-Density Lipoprotein (LDL): This test measures the amount of “bad” cholesterol in your blood.
People who have diabetes, abnormal cholesterol tests and/or other risk factors are at increased risk for
developing heart disease. Early detection of increased LDL and treatment can help to prevent this
complication. Most people with diabetes should have their blood cholesterol checked at least once a
year.
Pneumococcal vaccine: The pneumococcal vaccine helps prevent pneumonia in people with diabetes.
People with diabetes should receive this vaccine at least once during their lifetime.
Office check-up: To help you take care of your diabetes and make sure you receive appropriate care, it
is important that you have a check-up at least yearly, or more often if you are not feeling well.
Notes/Other:
Please call my office to arrange for the care that I have checked off above. Also, please call me if you have any
questions or concerns about your health that you would like to discuss, and remember to call my office every
fall for a flu shot.
Sincerely,
Charlie Jones, MD
Standards of Medical Care in Diabetes 2007 (ADA); Type 2 Diabetes in the Young: The Evolving Epidemic 2004; Care of Children and Adolescents
With Type 1 Diabetes: A statement of the American Diabetes Association 2005; Recommended Adult Immunization Schedule, United States, October
2006 – September 2007 (ACIP/ACOG/AAFP); Recommended Immunization Schedule for Persons Aged 0 –18 Years, United States, 2007
(ACIP/AAP/AAFP)
MDDIA-LTR-HD-0706
© Health Dialog 2007