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Dear Doctor,

Your patient can benefit from our Diabetes classes, referral is simple

To refer your patients for diabetes education classes, please complete our DSME referral form and fax it to us at 1(276)935-2082

Referral Process and instructions for filling out DSME referral form:

 

Give the original form to your patient. Our staff will call your patient and schedule classes with the pharmacist within 2 weeks of your referral.

Classes will be held at diabetes center most convenient for your patient If your patient misses a scheduled class, our Staff will attempt to reschedule

Once your patient has completed his or her classes, we will send you a follow- up report by fax or electronically.

Please not the following information must be included on the referral form in order for us to provide the services on a timely manner:

1- Diabetes diagnosis

2- Recent A1c test result

3- Blood pressure reading

4- Your Signature and NPI number

If you have questions or if you are interested in other services such as Medication therapy management (MTM) or Medical Nutrition Therapy (MNT), please feel free to contact us at 1(276)935-2080

Please remember that we can provide the services to your patient at your site or ours

Please fill out this referral form now

Thank you for your referral The PIDO project Team

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