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To enter more than one report use the same form.

Enter Blood Sugar Report Information * Indicates compulsary fields.

Date Of Checkup*

Report For

Time

Blood Sugar %

Urine Glucose %

Acetone Bodies

Normal Range
(Min. - Max.)

Fasting

hr. mins

2 Hrs after lunch/After taking 100 gms of glucose

hr. mins

Any Other information
(details of diets/medicine taken)

Warning: Please find and enter all the fields accurately from your report (Hard Copy)


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