Referral and Education Station

1. To explain the finding/ results to the patient, and their associated risk category.
2. To educate the patients on sugar-control, by answering their questions and providing an
infograph where patient can access via their mobile phone (Appendix 1)
3. Refer the patients for appropriate dental/ medical management using the referral form
(Appendix 2).
4. To explain data entry for all patients screened, including patient details, demographic,
anthropometric, glucose reading, and risk assessment.
Appendix 1
Appendix 2

UKM Letter Head

Patient Details Date: ___________

Name :
IC :
Gender : M / F
DOB/ Age :
Mobile phone :

Screening Findings
BP :
RBS :
Height :
Weight :
BMI :

To whom it may concern,

The patient above was screened in conjunction with the Diabetes Awareness Week at the Faulty of
Dentistry, University Kebangsaan Malaysia (UKM), and found to be in the high-risk group for
diabetes.

The findings are as above.

The patient also has a concern of:

The patient has these underlying medical conditions:

We are referring this patient for further management under your care. Kindly do the needful.

Thank you.