INNOVATIVE PRACTICE FORM

Name: Debra G. Singer, R.Ph., C.D.E.

Address:Ask Your Pharmacist, Inc., Gull Road Pharmacy, 1522 Gull Road, Kalamazoo, MI 49001

Phone #: 616-345-8543

FAX #: 616-345-5272

Briefly describe innovation

Consultation practice in diabetes and hormone replacement therapy (per referral, physician or patient). Includes history, assessment, evaluation, therapy recommendation, formulation when required and dosing, patient education, review and follow-up with p atient and physician.

Method of Reimbursement

Payor(s): patient

Reimbursement rate: $40-70 per consult

Is documentation required? Yes written patient records; form not developed yet

Specialized training required? Yes Certified Diabetes Educator

Software/instrumentation required? No (would be nice!)