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Blood Sugar Tracking Form
Client Name _______________________________________
Date
AM/PM
Time
Signature
______________________
______________________
______________________
______________________
Reading
Staff
Int.
Date
____________
____________
____________
____________
Date
Month _________________
AM/PM
Time
Reading
Signature
______________________
______________________
______________________
______________________
Staff
Int.
Date
____________
____________
____________
____________
DR Ordered Blood Sugar Levels
Waking up (before breakfast)
Before Meals
2 hours after meals
At bedtime
_____to_____
_____to_____
_____or less
_____to_____
Revised 7/08
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