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The document is a Physician's Referral Form for diabetes patients in Singapore, detailing personal biodata, recent investigation reports, required services, and payment options. It includes sections for patient information, diabetes type, investigation results, and various diabetes management services available at designated care centers.

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How to use or fill out the Physician’s Referral Form for Diabetes Singapore

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Click ‘Get Form’ to open it in the editor.
Begin with Section A: Personal Biodata. Fill in the patient's name, NRIC, sex, date of birth, age, and preferred language of instruction. Ensure all fields are completed accurately.
In Section B: Recent Investigation Report, input the relevant investigation results such as HbA1c and blood sugar levels along with their respective dates.
Proceed to Section C: Services Required. Tick the boxes for services applicable to the patient, including options like Diabetes Retinal Photography and specialized care by a dietician.
Finally, complete Section D: Payment. Indicate how payment will be processed and ensure that the doctor’s signature and date are included at the bottom.

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