MIDWESTERN ENDOCRINOLOGY, P by 0DgXu2U

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									                           MIDWESTERN ENDOCRINOLOGY, P.A.
                               5401 College Blvd. Suite 110
                                Overland Park, Ks. 66211
                                   (913) 451-9888
                                 FAX: (913) 451-2651
                                  www.kcendocare.com


Name:                                                         Phone:


Diabetes Pills and Dosages:




Insulin Doses:


                   Breakfast          Lunch            Dinner        Bedtime OTHER
 DATE             Before   After   Before   After   Before   After




COMMENTS:



(Orig. 02/2002)

								
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