Diabetes Prevention and Control Program - Publication Order Form
- The "Diabetes Publication Order Form" also exists in PDF format (PDF, 35KB)
Quantities of the publications listed on this sheet are available free of charge to New York State residents and organizations. To place an order, please circle the quantity desired and fill out the requestor information below. Forms may be faxed, mailed or e-mailed as specified below.
- Fax: (518) 465-0432
- Mail: New York State Department of Health, Distribution Center, 21 Simmons Lane, Menands, NY 12204
- E-mail: b0019w@health.state.ny.us
Requestor Information
| Name: | ______________________________________________________ |
|---|---|
| Organization: | ______________________________________________________ |
| Address: | ______________________________________________________ |
| City, State, ZIP Code: | ______________________________________________________ |
| Telephone Number: | ______________________________________________________ |
| Date: | ______________________________________________________ |
Would you like a copy of our publication catalog? (circle one)
- Yes
- No
| Title | Type | Language | Code Number | Circle Quantity | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Household Sharps: How to Dispose of Them Properly | Brochure | English | 0909* | - | 5 | 10 | 25 | 50 | 100 | |
| Spanish | 0941* | - | 5 | 10 | 25 | 50 | 100 | |||
| Hello Neighbor (Hola Vecino) | Cookbook | English | 0913 | 1 | - | - | 25 | 50 | - | |
| Spanish | 0914 | 1 | - | - | 25 | 50 | - | |||
| It's Never Too Early to Prevent Diabetes. A Lifetime of Small Steps for a Healthy Family | Tip Sheet for women with a history of gestational diabetes | English | 0921* | 1 | - | - | 25 | 50 | - | |
| Fit and Fabulous As You Mature | Brochure designed to help women to move more and eat better | English | 0922 | 1 | - | - | 25 | 50 | 100 | |
| Diabetes Management Guidelines for Adult Diabetes Care/Diabetes Mellitus Flow Sheet | Guidance Document | English | 0923* | - | 5 | 10 | 25 | 50 | 100 | |
| Manage Your Diabetes For A Healthy Life | Brochure | English | 0925* | - | 5 | 10 | 25 | 50 | 100 | |
| Manage Your Diabetes For A Healthy Life | Poster | English | 0926* | 1 | 5 | 10 | - | - | - | |
| Administering Glucagon (One Page Summary) | Poster | English | 0928* | 1 | 5 | 10 | - | - | - | |
| You Have the Power To Prevent Type 2 Diabetes & "Healthy Plate" Food Choice Guide |
Lifestyle Modification Tool |
English | 0929* | - | 5 | 10 | 25 | 50 | 100 | |
| Eye Examination Report for Diabetes | Documentation Tool | English | 0930* | - | 5 | 10 | 25 | 50 | 100 | |
| Am I at Risk for Type 2 Diabetes? | Booklet | English | 0932* | - | 5 | 10 | 25 | 50 | 100 | |
| Your Game Plan for Preventing Type 2 Diabetes | Booklet | English | 0933* | - | 5 | 10 | 25 | 50 | 100 | |
| Helping Your Overweight Child | Booklet | English | 0934* | - | 5 | 10 | 25 | 50 | 100 | |
| Lower Your Risk for Type 2 Diabetes – Tips for Kids | Tip Sheet | English | 0936* | - | 5 | 10 | 25 | 50 | 100 | |
| Vision Impairment & Diabetes-5 Key Messages | Fact Sheet | English | 0939* | - | 5 | 10 | 25 | 50 | 100 | |
| Personal Diabetes Care Card | Wallet Card | English | 0942* | - | 5 | 10 | 25 | 50 | 100 | |
| Spanish | 0907* | - | 5 | 10 | 25 | 50 | 100 | |||
| French | 0974 | - | 5 | 10 | 25 | 50 | 100 | |||
| Chinese | 0975 | - | 5 | 10 | 25 | 50 | 100 | |||
| Russian | 0976 | - | 5 | 10 | 25 | 50 | 100 | |||
| Children with Diabetes, A Resource Guide for Families and Schools | Book | English | 0944* | 1 | 5 | 10 | - | - | - | |
| 1 carton (38 books) | ||||||||||
| Diabetes Foot Poster (a reminder to remove shoes and socks for foot exams) | Poster | English | 0946* | - | - | - | - | - | - | |
| Spanish | 0946* | - | - | - | - | - | - | English/Spanish (dual language poster) | 0946 | 1 | 5 | 10 | - | - | - |
| Portion Plate-Adult | Depicts serving sizes for adult food portions | English | 1612 | 1 | 5 | 10 | 25 | - | - | |
| BMI Chart for Boys Ages 2-20 | Chart Tool | English | 4948* | 1 pad of 50 | ||||||
| BMI Chart for Girls Ages 2-20 | Chart Tool | English | 4949* | 1 pad of 50 | ||||||
| Pediatric/Adolescent BMI Calculator Wheel | Health Care Provider Tool |
English | 4950* | 1 | 5 | 10 | - | - | - | |
| AAP recommendations for prevention of pediatric overweight and obesity/Steps to Calculate BMI | Guidance Tool | English | 4951* | 1 | 5 | 10 | - | - | - | |
| Take Charge of Your Diabetes | Booklet | English | 0915 | 1 | 5 | 10 | 25 | - | - | |
| Spanish | 0920 | 1 | 5 | 10 | 25 | - | - | |||
| How Do You Control Your Diabetes? Don't Panic: ESAP Can Help! | Brochure | English | 9458* | - | 5 | 10 | 25 | 50 | 100 | |
| Spanish | 9459* | - | 5 | 10 | 25 | 50 | 100 | |||
| Chinese | 9460 | - | 5 | 10 | 25 | 50 | 100 | |||
| How Can You Dispose of Used Sharps Safely? | Poster | English | 9461 | 1 | 5 | 10 | - | - | - | |
| Spanish | 9462 | 1 | 5 | 10 | - | - | - | |||
| Chinese | 9463 | 1 | 5 | 10 | - | - | - | |||
| How Can You Dispose of Used Sharps Safely? | Easel Counter Top Display |
English | 9464 | - | 5 | 10 | 25 | 50 | 100 | |
| Spanish | 9465 | - | 5 | 10 | 25 | 50 | 100 | |||
| Chinese | 9466 | - | 5 | 10 | 25 | 50 | 100 | |||
| Prisoner Diabetes Handbook | Book | English | 0971 | 1 | - | 10 | 25 | 50 | 100 | |
| Prevent Type 2 Diabetes Step by Step (Paso a Paso) | Poster | English | 0905 | 1 | - | 10 | 25 | 50 | 100 | |
| Flyer | English/Spanish | 0902 | 1 | - | 10 | 25 | 50 | 100 | ||
| Potholder | Spanish | 1 | - | 10 | 25 | 50 | 100 | |||
| I Control My Diabetes | Poster | English | 0903 | 1 | - | 10 | 25 | 50 | 100 | |
| Bookmark | English | 0967 | 1 | - | 10 | 25 | 50 | 100 | ||
| Flyer | English | 0901 | 1 | - | 10 | 25 | 50 | 100 | ||
| I Am Loving and Capable (IALAC): A Day in the Life of a Child with Diabetes | Video | English | 0927 | 1 | 5 | 10 | - | - | - | |
| Cookin' with the Network | Cookbook | English | 0937 | 1 | - | - | 25 | 50 | - | |
| 4 Steps to Control Your Diabetes For Life | Booklet | English | 0970 | 1 | - | - | 25 | 50 | - | |
| Weekly Food & Activity Tracker | Booklet | English | 0994* | 1 | - | 10 | 25 | 50 | 100 | |
| Could You have Pre-Diabetes? | Booklet | English | 0995 | 1 | - | 10 | 25 | 50 | 100 | |
*The marked publication may be printed individually on your printer, or you may access the separate Printable Publications page here.
