[Nj-diabetes-division] ADS Ordering of Diabetic Supplies & Glucose Logs

Tue Oct 2 18:49:15 UTC 2012

this did not print can you put it into word format.  thank you.

In a message dated 10/1/2012 1:44:21 P.M. Eastern Daylight Time,  
etscrivani at verizon.net writes:

Hi folks:

For those interested in what ADS is asking for in the form of  
documentation to re-order diabetic supplies, below is what the paperwork in  the 
shipment of testing supplies states & asks for.  At the top it  indicates who it 
will require the logs from.  I was asked because I’m  insulin dependant & test 
at least 4 times per day, and according to the  statement if I only tested 
3 time per day I would not be bothered for this  documentation. 

I scanned this in K1,000 so just ignore any bad formatting, you’ll get  the 
gist  ....

LAST NAME: 
ADDRESS:                                                                    
          PHONE: 
CITY: 
STATE: 
ZIP: 
Ana Bermejo EX 7015
4fe<w

DVANCED ™
DIABETIC S LUTIONS

To place an order, please call our customer service department at  
1-888-377-6382; or visit us at    www.AdvancedDiabeticSolutions.net.

If you are required to test more than Medicare's usual and  customary
guidelines (three (3) times per day if you are receiving insulin  
injections OR
one (1) time per day if you are noninsulin -dependent),
.ve will need you to send us a copy of your blood glucose log.
Please include the following information:

1) Make sure your first and last name are printed on
both sides of the blood glucose log; 
2) Make sure your blood glucose log is dated by month, date and year;  
3) Make sure to include at least 28 days in a row of testing  
documentation; -; The blood glucose log must show testing dates of
one month before the date of the order.

You may send or fax an original or photocopy of your blood glucose log to  
the attention of:

Advanced Diabetic Solutions, LLC
1576 Atkinson Road
Lawrenceville, GA 30043

Fax: 770-339-1192    Phone: 1 -888-377-6382

Please note: Hygienic reasons prevent us from accepting logs stained with  
blood.

Date MM DD/YY) 
Time 
Blood
Glucose
Results 
Time 
Blood
Glucose
Results 
Time 
Blood
Glucose
Results 
Time 
Blood
Glucose
Results 
Time 
Blood
Glucose
Results 
Time 
Blood
Glucose
Results 
Time 
Blood
Glucose
Results 
~-"='"~'V 
7:00 a.m. 
770 
11:00 a.m. 
720 
i:occ."-.    ':¦¦: 
5;00 p.m 
7 30 
7:00 p.m. 
775 
10:00 a.m. 
705 

j 

i 

i 

i 

I 

i 

J

LAST NAME: 
ADDRESS:                                                                    
          PHONE: 
CITY: 
STATE: 
ZIP: 
Ana Bermejo EX 7015
4fe<w

DVANCED ™
DIABETIC S LUTIONS

To place an order, please call our customer service department at  
1-888-377-6382; or visit us at    www.AdvancedDiabeticSolutions.net.

If you are required to test more than Medicare's usual and  customary
guidelines (three (3) times per day if you are receiving insulin  
injections OR
one (1) time per day if you are noninsulin -dependent),
.ve will need you to send us a copy of your blood glucose log.
=lease include the following information:

i) Make sure your first and last name are printeu on
both sides of the blood glucose log; 2i Make sure your blood glucose log  
is dated by month, date and year; 3i Make sure to include at least 28 days in 
 a row of testing documentation; -; The blood glucose log must show testing 
 dates of
one month before the date of the order.

You may send or fax an original or photocopy of your blood glucose log to  
the attention of:

Advanced Diabetic Solutions, LLC
1576 Atkinson Road
Lawrenceville, GA 30043

Fax: 770-339-1192    Phone: 1 -888-377-6382

Please note: Hygienic reasons prevent us from accepting logs stained with  
blood.

Date MM DD/YY) 
Time 
Blood
Glucose
Results 
Time 
Blood
Glucose
Results 
Time 
Blood
Glucose
Results 
Time 
Blood
Glucose
Results 
Time 
Blood
Glucose
Results 
Time 
Blood
Glucose
Results 
Time 
Blood
Glucose
Results 
~-"='"~'V 
7:00 a.m. 
770 
11:00 a.m. 
720 
i:occ."-.    ':¦¦: 
5;00 p.m 
7 30 
7:00 p.m. 
775 
10:00 a.m. 
705 

j 

i 

i 

i 

I 

i 

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