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doc11745 Diabetes_Referral_Form_2015-_New_Codes.pdf_t_202401252022570.pdf

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Page 1

166 item(s) JSON
figure (1) form_field (58) formula (1) header (1) heading (15) list (5) list_item (14) table (3) table_cell (32) text (35) title (1)
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Table integrity: 1 of 6 cells don't match the text layer at their coordinates.
r2c0 (50%): “□ R73.∅9 PreDiabetes”
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            "text": "Obesity"
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                    "text": "Coronary Artery Disease □ Retinopathy",
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            "text": "Pregnancy"
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            "text": "Mental/affective disorder\nChronic Renal Insufficiency"
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            "id": "p1.52",
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            "bbox": {
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            "text": "Any Other Special Instructions/Behavioral Goals or Plans",
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            "level": 3
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        {
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            "text": "-Frequency of Blood Glucose Testing: ___",
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            "text": "[p1.55.2]REQUIRED-Physician Signature:___ NPI#:___ Date:___/___/___",
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                    "text": "^{*}",
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            ]
        },
        {
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            "text": "Please FAX or MAIL this completed referral form to the Surry County Health & Nutrition Center 118 Hamby Road, Dobson, NC 27017; FAX (336) 401-8408; Phone (336) 401-8419"
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    "excluded_furniture": {
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        "last": []
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