Diabetes Annual Comprehensive Review Note

Date: [Date of service]

Patient: [Patient name and identifiers]

Provider: [Provider name, credentials]

Visit Type: [Annual Diabetes Comprehensive Review / other visit type]

Data Sources: [Patient interview, device uploads, outside records, etc.]

Diabetes Summary

• Diabetes type & duration: [Type; year of diagnosis; duration] (If unknown, enter "Unknown/not on file — [action taken]")
• Current regimen: [All diabetes medications with doses; insulin delivery method if applicable]
• Technology: [CGM / pump / AID / connected pen / none]
• Most recent A1c: [Value; date; source] (Label patient-reported if applicable; if unknown, "Unknown/not on file — records requested")
• CGM summary: [Reporting window; TIR %; TBR %; GMI] (Include only if CGM data available)
• Complications status:
  • Retinopathy: [Status; last exam date; source]
  • Nephropathy/CKD: [Stage if applicable; last eGFR value/date; last UACR value/date]
  • Neuropathy/foot risk: [Status; last exam date; risk category]
  • ASCVD/HF: [Known status; pertinent dates if provided]
• Safety risks: [Severe hypoglycemia history; hypoglycemia unawareness; DKA/HHS history; prior foot ulcer/amputation] (Include dates/frequency if known)
• Active care team: [Endocrinology, ophthalmology, podiatry, diabetes education, others as applicable]

Subjective

[Reason for visit in one sentence]

(Summarize interval history since last comprehensive review using brief narrative. Do not include templated "all negative" ROS.)

• Acute care since last review: [Hospitalizations, ED visits, acute events with dates]
• Medications: [Changes, tolerability, adherence, access/cost barriers]
• Weight & lifestyle: [Weight change; nutrition; physical activity]
• New symptoms: [Vision changes, neuropathic symptoms, claudication, chest pain, dyspnea] (Include only symptoms reported)
• Glycemic self-management: [Hypoglycemia frequency/severity/awareness; hyperglycemia patterns; CGM/SMBG use]
• Patient priorities: [Patient-stated goals and concerns for today]

Surveillance & Preventive Care

(Track items relevant to this patient. For items not on file, write "Unknown/not on file — [planned action]". Remove rows not applicable.)

Domain	Last date	Result / Status	Action today
Kidney (eGFR, UACR)	[Date(s)]	[eGFR value; UACR value]	[Ordered / Up to date / Records requested]
Eyes (dilated exam or retinal screening)	[Date]	[Result; source]	[Referred / Records requested / Up to date]
Feet/Neuropathy (comprehensive exam, monofilament)	[Date]	[Findings; risk category]	[Performed today / Referred / Up to date]
Cardiovascular (BP trend, lipids, statin, smoking)	[Dates]	[BP summary; lipid values; statin status; smoking status]	[Medication changes / Labs ordered / Up to date]
Immunizations	[Date(s)]	[COVID-19; influenza; pneumococcal; hepatitis B]	[Administered / Deferred / Up to date]
DSMES/Nutrition	[Date of last referral]	[Status]	[Referred / Up to date / Declined]
Psychosocial (depression/distress screening)	[Date]	[Screening result]	[Screened today / Referred / Up to date]
Social determinants	[Date assessed]	[Food security, cost barriers, transportation as applicable]	[Resources offered / None identified]

Objective

Vitals: [BP (emphasize); other vitals as relevant; orthostatics if indicated]

Exam: [General appearance; cardiopulmonary findings; foot exam findings if performed today; injection/CGM sites if applicable] (Document pertinent positives and negatives only)

Data Reviewed: [Labs with dates; CGM/device report with reporting window; outside records reviewed] (Note expected data that was unavailable)

Assessment & Plan

(Order problems by clinical priority: safety concerns first, then organ-threatening risks, then optimization. Label patient-reported outside results as such. Do not establish diagnoses requiring persistence from a single abnormal value—note as abnormal screening with repeat planned.)

[Problem 1]: [Diagnosis or condition]

• Status: [Controlled / Uncontrolled / Stable / Progressing] — [key supporting data with dates]
• Goal: [Individualized treatment target]
• Plan: [Medication changes; orders; referrals; education; barrier mitigation; monitoring and safety considerations]

[Problem 2]: [Diagnosis or condition]

• Status: [Status with dated data]
• Goal: [Goal]
• Plan: [Interventions, orders, monitoring]

(Add additional problems as needed: hypertension, dyslipidemia, CKD/albuminuria, retinopathy, neuropathy/foot risk, ASCVD/HF, obesity, tobacco use, vaccination gaps)

Follow-up

[Follow-up interval and modality] — Return sooner if: [safety triggers such as frequent hypoglycemia, foot wound, acute vision change]