Community Health Hero Nomination Form Munson Healthcare recognizes individuals and organizations in our community who contribute significantly toward improving the health and wellness in the communities we serve. These are our Community Health Heroes. Factors that go into the recognition include programs and services that: Improve access to care. Address the unmet health needs of the uninsured, underinsured and disenfranchised. Address the unmet or emerging health issues of the youth and elderly. Focus on chronic disease prevention and management. Please complete the following form to nominate

Community Health Heroes from Previous Years Here are the Community Health Hero Recipients from previous years. 2018 Recipients Cyndi Jacobi, SEA (Substance, Education, and Awareness) Manistee Coalition Volunteer Honored by Manistee Hospital for her role and involvement in volunteering for the SEA Manistee Coalition. Cyndi also was involved in hosting the 2018 Regional Opioid Symposium, has offered the Cooking Matters Classes for patients, and hosts many other health-related activities through her work at MSU Extension. Health Department of Northwest Michigan Honored by Charlevoix Hospital for

Program Forms Munson Healthcare Referral Form Diabetes Self-management Education/Training and Medical Nutrition Referral Form (pdf) Grayling Hospital Forms [diabetes assessment form pdf is in g: folder] Munson Medical Center Forms Pre-diabetes Self-assessment questionnaire (pdf) Personal health goals form (pdf) Diabetes (Type 1 and 2) Self-assessment questionnaire (pdf) Personal health goals form (pdf) Gestational Diabetes Self-assessment questionnaire (pdf) Personal health goals form (pdf)

Diabetes Education Program Forms Provider Forms Munson Healthcare Diabetes Self-management Education/Training and Medical Nutrition Referral Form (pdf) Cadillac Hospital Diabetes Education Referral (pdf) Munson Medical Center Diabetes Self-Management Education/Training and Medical Nutrition Referral Form (pdf) Patient Forms Munson Medical Center Pre-diabetes Self-assessment Questionnaire (pdf) Diabetes (Type 1 and 2) Self-assessment Questionnaire (pdf) Gestational Diabetes Self-assessment Questionnaire (pdf)

Find a Diabetes Education Program Near You Classes vary by location. Call the Diabetes Education office nearest you to learn more about classes and events in your community or to make an appointment. Talk to your provider to learn more about Diabetes Education programs in your local area. Telehealth appointments may also be available. Cadillac Hospital - Diabetes Education Services 400 Hobart St. Cadillac, MI 49601 231-935-8200 or 800-809-8127 Phone hours: 9am - 4pm Kalkaska Memorial Health Center - Diabetes Education Services 419 S. Coral St. Kalkaska, MI 49646 231-258-3091 Munson

Dr. Comfort Diabetic Shoes Today’s diabetic shoes come in many colors and styles – just like regular shoes. Diabetic shoes are specially constructed to protect your feet. They are extra deep to accommodate special custom made inserts. Special features and materials combine to provide your feet with the extra protection and extra comfort they need. Dr. Comfort Shape to Fit Socks are also available. Qualifying for Medicare Reimbursement To qualify for Medicare reimbursement, specialized diabetic shoes and inserts must be prescribed by your physician and professionally fit by certified staff at

Oncology Pharmacy Specializes in Cancer Care The Cowell Family Cancer Center Oncology Pharmacy serves patients receiving cancer treatment and is staffed with clinical pharmacists, many of whom are board certified in oncology pharmacy. Oncology pharmacists are available to provide information to physicians, staff, patients, and family members. They work collaboratively with the medical team to ensure accurate, individualized patient dosing, safety checks, and adherence to treatment plans and schedules. Pharmacists also participate in tumor board discussions, cancer research, and serve as

Patient Centered Medical Homes The following Munson Healthcare physician offices are recognized as Patient Centered Medical Homes: Kalkaska Medical Associates Manistee Primary Care Manistee Internal Medicine Munson Family Practice Center OMH Medical Group – Family Practice OMH Medical Group - Indian River OMH Medical Group – Internal Medicine OMH Medical Group - Lewiston OMH Medical Group - Pediatrics A Patient Centered Medical Home is not a place – it refers to a partnership with your primary care provider. Patient Centered Medical Home practices have been recognized by certain insurers for

Pulmonary and Respiratory Diagnostic Testing The first step to fixing a breathing problem is finding its cause. Munson Healthcare pulmonary specialists and respiratory therapists are standing by to accurately diagnose your problem and make a plan to help you breathe better. 6-minute walk Arterial/capillary blood gas sampling Conserving device evaluation Home oxygen qualification Pulmonary function test Pulmonary rehab consultations Pulse oximetry Sleep studies