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Certified Diabetes Educator (CDE) Referral Form


This referral form, created by Chautauqua County Health Department (NY), is a useful tool for use by medical providers to refer patients to Certified Diabetes Educators (CDEs).  It provides the clinician with an easy-to-use chart for indicating:

  • Patient diagnosis,
  • Purpose of referral,
  • Results of lab work,
  • Diabetes complications,
  • Existing barriers to care,
  • Exercise prescription, and
  • Current medications.




Primary Toolkit:

Chronic Disease Prevention Toolkit

Secondary Toolkits:

CDC Winnable Battles

Keyword Area:

Chronic Disease, Obesity


100,000 - 149,999

Institutional Author:

Chautauqua County Health Department (NY)





The NACCHO Toolbox is a repository of available resources to help local public health practitioners. Tools are produced by local, state, and federal agencies, as well as academic institutions and other stakeholders. The contents of this Toolbox are solely the responsibility of the authors and do not necessarily reflect any official recommendations of NACCHO. NACCHO makes no express or implied warranty with respect to the contents and disclaims liability for any damages arising from or connected to the use of the material in this Toolbox.