Appendix

2: Referral Checklist

Step 1: Utilize the screening tool to determine which patients
are appropriate for an outpatient diabetes education referral

Step 2: If appropriate, refer your patient to the outpatient
diabetes class by providing them with a class schedule

Step 3: Motivate your patient by stressing their attendance

Step 4: Give a brief overview of the class
o Duration
o Topics covered
o Payment Options

Step 5: Ask the patient if they would like a follow-up reminder
via email or phone regarding the class.

Step 6: Retrieve the patients contact information if applicable.

Step 7: Leave your patient with a positive attitude towards
diabetes self-management education