HOJA DE COTEJO NIVELES DE AZUCAR EN SANGRE FECHA] ANTESOEL | ANTES DEL | ‘AL | DURANTE LA | CETONAEN LA | | DESAYUNO | ALMUERZO CENA __| ACOSTARSE NOCHE | _ORINA _| ts to Heese ale us | fee pa ! 579 | 47 j | 14 | jt - i \ | | y ‘ \ NOMBRE DE moore Nacle A Cansaler Vesa. | FECHA DE VISITA:, sI3izs | DOSS DE INSULINA: | “ANTES DELDESAYUNO | ANTES DELALMUERZO | ANTESDELACENA | ANTESDELAMERIENDA | | A U Aes f NUEVA DOSIS NUEVA DOSIS: NUEVA DOSS NUEVA DOSIS nD q Y Ze tSt. Luke's Episcopal Hospital R-Pediatric Discharge Summary Patient Name: Gonzalez Vera, Victoria Alejand Unit Number: ML01027415 Date of Birth: 06/28/2015 Patient Status: Admitted Inpatient Attending Doctor: Aranda Vicente, Maria MD 08320 ‘Account Number: VL4001687193 Pe Summary Pediatric Discharge Summary Admission Date Apr 18, 2023 Discharge Date Apr 21, 2023 Admission Diagnosis Uncontrolled hyperglycemia Diabetes de novo Principal iagnosis Diabetes Melitus pe 1 Hospital Course Services: ‘Social Work Health educator Psychology Nutrcionist Dr inzarry (Ped endo) Infections: Ni Condition on Discharge: Improved Level of conciousness on Depar: Alert Prognosis: Good Vaccination: Admin/Date Influenza: No Pneumococcal: No Hepatitis B: No Final Disposition Home Discharge Instructions Physical Activities: Ambulatory Discharge Diet Diabetic Discharge Medication Humalog 4 units SC before each meal Lantus 7 units SC before last snack at 9pm Page 1 of 6SS — / ozoreno Reims pexcom henna Spee evades NEW - PATIENT ORDER INFO! ‘TION 0 ‘CO OMT2_[ teva Aaees: | [ze Phone: ; Sa | enecal te | iD or Convact® | civ Dal ct —L DUGNOR COE:ICD0om TeI0es Clewno Cena Cleves Ltasiproramy Om | |# Fingeratick por day: # injections per day: Wott _(bs) HoAtc— Result Instn regiment: CT Raping _taa nts pry) Lng Acrg tol nts or day fi PRESCRIPTION INFORMATION 8, 01 TANDEM t: slim x2™ Insulin Pump with Control1Q™ with Daxcom ICGM paren w/b intern ‘CARTRIDGE & INFUSION SET CHANGE FREQUENCY [C1] Every3 day (aty.20) C1] Every 2 day (Qt. 50) 1. LC Peteniceregiver hes completed dlabetes education (nduding carbohydrate courting) and is motivated to maintain opts! ‘Picoee contra 2 11 Patentvcaregiver hes the ability to operate and can use an ineuin pump to manage blood glucose. b. Cpexcom cs 9: Depenee 1 bow,» Tananiter—Dipanee2_ « Receiver -Dipenee 1 DEXCOM G7 ‘1 one-pack 10-dy seneor wth itograted Tranemiter 1 Receiver Dispense 1 i ‘CLINICAL CONSIDERATIONS: (C Recarig episodes envere rypepycerta EH of over gyeonic xcarions ‘Treg toque ol oan einer eghan, Deed en iapavic BOM or COM et roi ‘Drager evaenes,veverod Ee pty aren nao owpiaton/ 1 of 3-4 oF mor and oo sss natn domes TE Vario nthe dyo-dy echuddeendrexrdte prover e clever of euroesh emis owt WD B cosent nln Pug i cu of warty, ot ftenaly ro loge eda he patents mail reed. | Out ofwaranty St: ote aa: aba aoc (1A), ere Name: T Comments: Hl ‘PRESCRIBER PHYSICIAN INFORMATION, Physician: Lydia zary Gonzalar Enel Aldon: eieotnoege 4@gecon a ic Ponsa Pa 51 Bd Le Fae Sua 504 | Prone T7-aetet ‘ty Poes [site Pa zi. 0ort? —| New 74005010 PRUE TO Prectrg Pri Sores: oe [ow PHYSICIAN - VITAL —__ [omune Syag [ew 1639276770 = Saree Te ae Se Sesion cma Nowy tena i= ane Emalto: jirizary@nazarenollccom Jose lrizatry- 787-238-8820 ex hme tet ic somnnd en = ee |