Patient Initial Assessment-Diabetes Education Form Page 3
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Give a sample of your meals for a typical day:
Time: ________ Breakfast: _______________________________________________________________________
_____________________________________________________________________________________________
Time: ________ Lunch: _________________________________________________________________________
_____________________________________________________________________________________________
Time: ________ Dinner: _________________________________________________________________________
_____________________________________________________________________________________________
Time: ________ Snack: __________________________________________________________________________
Time: ________ Snack: _________________________________________________________________________
Time:________ Snack:__________________________________________________________________________
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