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Putnam Community Medical Center
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mins

Diabetes HRA

Are You at Risk?

At Putnam Community Medical Center, we know that the best weapons against diabetes are knowledge and treatment. So we recommend this simple survey.

Please Select Yes or No for each question!

Yes No
1. My weight is equal to or above that listed in the chart below? (Yes = 5 points, No = 0 points)
H 4'10" 4'11" 5'00" 5'01"
Lbs 129 133 138 143
H 5'02" 5'03" 5'04" 5'05"
Lbs 147 152 157 162
H 5'06" 5'07" 5'08" 5'09"
Lbs 167 172 177 182
H 5'10" 5'11" 6'00" 6'01"
Lbs 188 193 199 204
H 6'02" 6'03" 6'04"  
Lbs 210 216 221  
2. I am under 65 years of age AND I get little or no exercise during a usual day? (Yes = 5 points, No = 0 points)
3. I am between 45 and 64 years of age? (Yes = 5 points, No = 0 points)
4. I am 65 years old or older? (Yes = 9 points, No = 0 points)
5. I am a woman who has had a baby weighing more than nine pounds at birth? (Yes = 1 points, No = 0 points)
6. I have a sister or brother with diabetes? (Yes = 1 points, No = 0 points)
7. I have a parent with diabetes? (Yes = 1 points, No = 0 points)