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My Diabetes Report Note
Last updated on November 6, 2024.
My Diabetes Report Note
Purpose
- My Diabetes Communication Note aims to prevent diabetes from becoming more severe by connecting people with diabetes and their families with supporters (medical staff, nursing care staff, etc.) and sharing information and exchanging information. .
- The center of this note is the person with diabetes = "I". The goal of this note is not only to share information and exchange information between supporters, but also to record their thoughts and feelings about diabetes, so that the individual and the supporter can work together on diabetes treatment. .
How to use it
People with diabetes and their families should present this note to supporters such as family doctor and helpers.
How to use my diabetes communication note flyer (table)
How to use my diabetes communication note flyer (back side)
Specific way of writing for each page
About me (the entry field for the person and family)
My Diabetes Notice p. 2, 3
■Fill in your thoughts and feelings about diabetes.
【Q１】 What kind of disease is diabetes for you?
Example: You must be careful about eating and exercising
・I've heard that I can't see my eyes, so I'm scared.
【Q２】 Do you have anything to be careful about with diabetes?
Example: I use stairs as much as possible, not escalators.
・I love sweets, but I decide the number of times I eat myself and keep it.
【Q３】 How would you like to spend your time in the future?
Example) ・ I want to stay well so that I can continue my hobby Go.
Supported by the supporter (fill in the supporter)
My Diabetes Notice p.4,5
■Fill out what the supporter will support.
Target value (HbA1c)
Enter the value of HbA1c that family doctor targets.
Support comments
〇 Nutritionist
Example) ・ 3 meals are eaten properly and I think it's wonderful!
Let's aim to consume 350g of vegetables a day.
〇 Dentist
Example) ・ Let's visit Dentistry regularly without brushing your teeth after every meal.
Record page (fill in fields for the person, family, and supporters)
My Diabetes Communication Notes p.6~15
■Enter what you, your family and your supporter want to share information and exchange information.
〇 "Who?" → "Who?" → Fill in the order of "Contents (what)"
Example: "Family" → "To a doctor," → "I want to know about insulin injections again."
・"Helper," → "To a Dietitian," → "I want you to tell me a recipe that can eat a lot of vegetables."
※An example of how to write is also posted on my diabetes contact note flyer (PDF: 340KB).
〇 Confirmation column
In the "Confirm" field, the person who confirmed will sign.
By signing, you can see who confirmed it.
Download data
If the recording page is gone, it is also possible to print and use this data.
How to get it
■For people with diabetes and their families
- As you distribute in medical institution in the city, please talk with family doctor. If there is stock at the consultation destination, you can get it there.
- If you are not available at your GP, you can also get it at the window of Health Promotion Section Health and Welfare Center Health and Welfare Division in your ward. (Because the number is limited, please be sure to contact us in advance.)
■For medical staff
Please contact Yokohama City Hall Medical Care Bureau Cancer and Disease Control Division.
Phone: 045-671-2721 Fax: 045-664-3851
E-Mail address [email protected]
Through a co-creation business with Mitsubishi Tanabe Pharma Corporation, I have created and distributed my Diabetes Report Note.
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Inquiries to this page
Medical Care Bureau Regional Medical Department Cancer and Disease Control Division
Phone: 045-671-2721
Phone: 045-671-2721
Fax: 045-664-3851
E-Mail address [email protected]
Page ID: 854-967-005
