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American Diabetes Advocates
P.O. Box 371
Dewittville, NY 14728
Phone: (716) 499-5622

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First Name Last Name
Address
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A1c %
Fasting mg/dL (Glucose)
Breakfast mg/dL (Two hours after Breakfast)
Lunch mg/dL (Two hours after Lunch)
Dinner mg/dL (Two hours after Dinner)
Type of Drug Units or Milligrams
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