Att_20 Clinic Exam Hemoglobin Results Form

Hemoglobin A1c Results
Name: _____________
Date: __________
Assessment of Diabetic Symptoms
Have you previously been diagnosed with diabetes?

Yes

No

Results
We tested your blood for glucose (sugar). The result is shown below.
Hemoglobin A1c Result:

________ %

What do Hemoglobin A1c numbers indicate?
A1c measures what percentage of your blood cells that carry oxygen are coated with sugar. A high A1c
level may indicate a risk of developing diabetes or diabetes complications. The A1c test measures your
average blood sugar levels for the past two or three months instead of just at one point in time and can
identify people who should have further evaluation. Even if you have been told before that you have
diabetes, you should still share a high test result with your health care provider.

Interpretation and Advice


Your result is

A1c level higher than 5.7%

A1c level 5.7% or lower

V1.0 (07/02/13)

This is
considered

High

Normal

You are advised to
Your A1c level is high. You should see a health care
provider within one month. A high A1c level can be
a sign of pre-diabetes or increased risk of diabetes
complications.
Your A1c level is normal

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U.S. Department of Health and Human Services  National Institutes of Health  National Institute of Environmental Health Sciences