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EMBANKMENT HISTORY: Treatment Date, Dilution (in mg/kg/hr), Dilution (in mg/DL) (in mL/hr). Area (M). Total. Time (h). Amount to be Diluted (mL.) (in mL) Expiration Date, Dilution (in mg/ mL/hr). Total Dilution (1,000 mg/mL) Units. EXFOLIATION: Treatment Date of the fluid being infused to be used during the infusion. Dilution (in mg/mL/hr). Area (M). Total. Time (h). Expiration Date, Dilution (in mg/mL/ hr). Total Dilution (1,000 mg/mL) Units. EXAMPLE 2 DURATION OF THE MEDICAL EXAMINATION FOR EMBANKMENT EXAMINATION (a) The medical examination for assessment of the appropriateness of medical treatment or examination must include verification of the following: (1) A complete history must include the date, duration, symptoms, and any necessary diagnostic procedures that occur prior to the onset of symptoms of hypoglycemia. (See Table 3.) (2) Documentation to demonstrate the presence of diabetes. (3) Documentation to demonstrate that the patient has hypoglycemia and is aware of its symptoms. (4) Documentation to demonstrate that the patient is taking insulin or a diabetes medication. (b) The medical examination must include an evaluation of the patient's current and previous condition, blood pressure, and pulse rate. The medical examination must determine the presence of diabetes. (c) A complete medical history must be obtained. Documentation must include each of the following: (1) Patient's birthdate and place of birth. (2) Patient's date of birth, date of arrival in the United States, name, and place of residence. (3) Diagnosis of diabetes. (4) Patient's present and past medications; the time of commencement of such medications and any change in dose; the date of cessation or change in dosages of such medications; and any other information required to determine the treatment status. (5) Current blood pressure. (6) Patient's weight, height, and body mass index. (7) Results of blood test as indicated by the appropriate laboratory. (8) Treatment with and current levels of insulin or medication.

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