(Insert Logo and Address)

(Insert Date)

Dear (PATIENT NAME):

It has come to our attention that you may be overdue for some important testing that
helps us monitor your diabetes. Uncontrolled diabetes can lead to further complications,
and can even be fatal. That’s why we want to help make sure your condition is in control
by explaining the importance of some of these tests.

There has been growing concern about heart disease risks among people with diabetes. It
is recommended that your cholesterol be checked at least once each year to verify you
are at or below the target LDL (“bad cholesterol”) goal of ≤ 100mg/dL. High cholesterol,
along with high blood pressure, increases your risk for heart attack and stroke, which are
the leading causes of death for people with diabetes. You should be fasting for eight
hours or more when you get your cholesterol test, or lipid profile. Drinking water is
permitted.

The A1C test measures whether your average blood sugar levels have been in good
control over the previous three months. The typical goal for this test is ≤7.0. Patients with
diabetes who maintain near-normal A1C levels gain an extra five years of life, eight years
of eyesight, and six years of freedom from kidney disease, on average.

Monitoring your kidney function is another important piece of your overall diabetes care.
Diabetes accounts for almost 45 percent of new cases of kidney failure. A microalbumin
urine test will provide information regarding kidney function.

Our lab is open ________ through ___________ from ______a.m. to _______p.m to

conduct these tests. No appointment is necessary for lab work. Just bring this letter with
you.

r 80061 Lipid panel Code = 272.4

r 83036 HbA1c Code = 250.0
r 82043/82570 Urine for Alb/Cr ratio Code = 250.0

r We do not have record of a dilated eye exam in the past 12 months.

r We do not have record of a blood pressure measurement in the past 12 months.

If you have received any of these tests recently, please call us at (XXX-XXX-XXXX) so
we can update our records. Please call us to schedule an appointment for any questions or
concerns. We congratulate you on your willingness to take a role in improving your
health!

Sincerely,
(Provider’s name)