Case Form


Doctor information:

Name

email

Contact Phone

Hospital

Departament

Speciality

Address

Patient information:

Name

Date of birth

Sex

Medical history

Familiar history

Diabetes familiar history

Height, weight, BMI

Clinical history:

Diabetes diagnosis age

Diagnosis clinical history

Previous Treatments

Actual Treatment

Complementary tests:

Basal Glycaemia

HBA1C (basal and after treatment)

Antibodies

Other lab tests

Consent