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