Self-Monitoring Blood Glucose
SMBG Collected
Was Self-Monitoring of Blood Glucose Performed?
Yes
No
Device Identifier
Test Name
Specimen Type
Self-Monitoring of Blood Glucose Date
01 Jan 2000
SMBG Measurements
Timepoint of Measurement
Indicate if Measurement NOT Taken
What time was measurement taken?
Glucose Result
Glucose Result Unit
Pre-Morning Meal
12:00
mg/dL
mmol/L
Post-Morning Meal
12:00
mg/dL
mmol/L
Pre-Midday Meal
12:00
mg/dL
mmol/L
Pre-Evening Meal
12:00
mg/dL
mmol/L
Post-Evening Meal
12:00
mg/dL
mmol/L
Bedtime
12:00
mg/dL
mmol/L
Overnight
12:00
mg/dL
mmol/L
Next Day Pre-Morning Meal
12:00
mg/dL
mmol/L
*
Mandatory field