EV03
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [EV] [STR-DT] [END-DT]
IF KNOWN, SELECT CORRECT OME ITEM GROUP.
OTHERWISE ASK: Did [you/[PERSON]] obtain glasses or contact lenses, insulin, or other diabetic equipment or supplies since [START DATE]?
GLASSES OR CONTACT LENSES .............. 1 [BOX_06]
INSULIN ................................ 2 [BOX_06]
OTHER DIABETIC EQUIPMENT OR SUPPLIES ... 3 [BOX_06]
[Code All That Apply]
----------------------------------------------------
IF CODED ?2? (INSULIN), ADD ?INSULIN? TO PERSON?S-PRESCRIBED-MEDICINES-ROSTER, CREATING NECESSARY RECORDS FOR INSULIN.
----------------------------------------------------
----------------------------------------------------
IF CODED ?3? (OTHER DIABETIC EQUIPMENT OR SUPPLIES), ADD ?OTHER DIABETIC EQUIP/SUPPLIES? TO PERSON?S-PRESCRIBED-MEDICINES-ROSTER, CREATING NECESSARY RECORDS FOR ?OTHER DIABETIC EQUIP/SUPPLIES?.
----------------------------------------------------