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Diabetes Referral Form

https://www.princeedwardisland.ca/sites/default/files/forms/diabetes_referral_form.pdf
2016-10-26
Complete this form to refer or self-refer to the Provincial Diabetes Program or the Diabetes Drug Program .
Referral Provincial Diabetes Program and Diabetes Drug Program Refer to: 9 Provincial Diabetes Program Q Diabetes Drug program (Pharmacare) (check all that apply) Reason for referral: Q New diagnosis Q Re-referral Q Change of treatment Q Insulin...

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