"client_name","agent_name","agent_address","day","evening","cell","fax","agent_email","dob_mm","dob_dd","dob_yy","sex","feet","inches","weight","smoker","insurance_amount","insurance_type","additional_insured","other_company_mm","other_company_yy","other_company","rating","rated_table","diagnosis_age","control","oral_medication","insulin_administered","sugar_monitored","physician_visit","ekg_abnormal","insulin_reactions","coma","eye_trouble","heart_trouble","protein_urine","skin_ulcers","amputations","neuropathy","condition_other","AIC_test","AIC_level","treatment_now","constantlevels","blood_pressure","bloodpressure_mm","bloodpressure_yy","below_200","exercise_frequency","exercise_type","dead_relatives","relative_relationship1","relative_death_cause1","relative_relationship2","relative_death_cause2","relative_relationship3","relative_death_cause3","additional_info","Submit"
"Rob","","Keen","41241242","","","","afg@a.com","01","04","1955","M","6'","0""","150","yes","","Select one","","","","","declined","","","diet","","insulin pump","1 or 2 times/day","0-6 months","","","","","","","","","","","yes","select one","yes","0-6 months","","","","yes","select one","","yes","Relationship","","Relationship","","Relationship","","","Submit"
"LYNN","CLARK","PORTSMOUTH VA 23702","757-673-8944","SAME","N/A","N/A","ALWAYSKEITH1957@YAHOO.COM","08","19","65","F","5'","3""","140","no","","Select one","","08","04","NATIONWIDE","declined","","18","diet and insulin","","1 or 2 times/day","1 or 2 times/day","0-6 months","","","","","","","","","","","yes","below 7.5","no","more than 24 months","120/85","07","04","yes","2 times/week","WALKING","no","Relationship","","Relationship","","Relationship","","","Submit"
"Donnie Payne","11724 Veronica Rd.","North Little Rock,AR.,72118","501-803-3561","","501-744-0086","","donniepayne1234@yahoo.com","05","24","1957","M","5'","9""","150","no","10,000","Term","","","","","declined","","17","diet and insulin","","3 or more times/day","3 or more times/day","0-6 months","","","","","","","","yes","yes","","no","select one","yes","0-6 months","120/90","09","2004","no","1 time/week","sit ups","no","Relationship","","Relationship","","Relationship","","","Submit"
"GARY A BOOKER","76 CARTPATH DRIVE","MERIDEN,CT  06450","203 237 0094","","","","robbieb676@aol.com","07","11","1948","M","6'","2""","240","yes","100000","Term","","","","","declined","","52","diet and insulin","glucophage","1 or 2 times/day","3 or more times/day","0-6 months","","","","","","","","","","","yes","below 7.5","yes","more than 24 months","","","","yes","2 times/week","","yes","brother","heart attack","Relationship","","Relationship","","","Submit"
"Frieda Mcneil","23 Westmont Dr","Hampton va 23666","757 766-7444","","","","fmac757@msn.com","05","30","1953","F","5'","7""","213","no","75000","UL","","","","","declined","","47","diet and insulin","","1 or 2 times/day","1 or 2 times/day","0-6 months","","","","","","","","","","","yes","select one","yes","0-6 months","","09","2004","yes","4 times/week","walking","no","Relationship","","Relationship","","Relationship","","","Submit"
"Jerome Donato","12825 Bristol","Grandview, Mo 64030","8169660831","8169660831","","","rdonato@pmlights.com","08","15","1945","M","5'","9""","243","no","","Term","","","","","declined","","54","diet and insulin","","3 or more times/day","3 or more times/day","0-6 months","","","","","","","","yes","","","yes","7.6-10","yes","0-6 months","121/70","10","04","yes","more than 7 times/week","pt","no","mother","breast cancer","Relationship","","Relationship","","recently lost the right foot.","Submit"
"Sal F. Coriale","5204 Sagecircle South","Houston, TX  77056","713-439-1421","713-439-1421","N/A","N/A","GayleVC@Wt.net","11","19","1949","M","5'","11""","167","no","150,000","Term","","","","","declined","","52","diet and oral","gugapage","insulin pump","1 or 2 times/day","0-6 months","","","","","","","","","","","yes","below 7.5","yes","0-6 months","","10","2004","yes","3 times/week","walking, exercise machines","no","Relationship","","Relationship","","Relationship","","","Submit"
"Irvin L. Oberfeld","8625 Allenswood Rd","Randallstown, MD 21133","410-922-2569","410922-2569","","","ioberfeld@yahoo.com","02","23","33","M","5'","8""","170","no","","Term","","","","","declined","","71","diet and oral","avandamet hyzaar","insulin pump","1 or 2 times/day","0-6 months","","","","","","","","","","","yes","below 7.5","yes","6-12 months","120/62","10","04","yes","7 times/week","walking","no","Relationship","","Relationship","","Relationship","","","Submit"
"Irvin L. Oberfeld","8625 Allenswood Rd","Randallstown, MD 21133","410-922-2569","410922-2569","","","ioberfeld@yahoo.com","02","23","33","M","5'","8""","170","no","","Term","","","","","declined","","71","diet and oral","avandamet hyzaar","insulin pump","1 or 2 times/day","0-6 months","","","","","","","","","","","yes","below 7.5","yes","6-12 months","120/62","10","04","yes","7 times/week","walking","no","Relationship","","Relationship","","Relationship","","","Submit"
"Irvin L. Oberfeld","8625 Allenswood Rd","Randallstown, MD 21133","410-922-2569","410922-2569","","","ioberfeld@yahoo.com","02","23","33","M","5'","8""","170","no","","Term","","","","","declined","","71","diet and oral","avandamet hyzaar","insulin pump","1 or 2 times/day","0-6 months","","","","","","","","","","","yes","below 7.5","yes","6-12 months","120/62","10","04","yes","7 times/week","walking","no","Relationship","","Relationship","","Relationship","","","Submit"
"Irvin L. Oberfeld","8625 Allenswood Rd","Randallstown, MD 21133","410-922-2569","410922-2569","","","ioberfeld@yahoo.com","02","23","33","M","5'","8""","170","no","","Term","","","","","declined","","71","diet and oral","avandamet hyzaar","insulin pump","1 or 2 times/day","0-6 months","","","","","","","","","","","yes","below 7.5","yes","6-12 months","120/62","10","04","yes","7 times/week","walking","no","Relationship","","Relationship","","Relationship","","","Submit"
"Fernando L Diaz","8608 Danza del Sol Dr","Las Vegas NV 89128","702 562-9052","","","","amboye@aol.com","07","06","66","M","5'","10""","240","no","500,000","Term","","02","2004","Farmers","declined","","38","diet and oral","glucophage","insulin pump","1 or 2 times/day","0-6 months","","","","","","","","","","","yes","select one","yes","6-12 months","","09","04","yes","2 times/week","walking","no","Relationship","","Relationship","","Relationship","","","Submit"
"Chris Erickson","16248 NE 143rd St.","Woodinville WA 98072","425-483-1326","","","","ican2ican2@aol.com","10","19","74","M","6'","1""","180","no","250,000","Term","","","","","declined","","5","diet and oral","insulin injections","3 or more times/day","1 or 2 times/day","0-6 months","","","","","","","","","","","yes","7.6-10","yes","more than 24 months","","","","yes","7 times/week","","no","Relationship","","Relationship","","Relationship","","","Submit"
"Chris Erickson","16248 NE 143rd St.","Woodinville WA 98072","425-483-1326","","","","ican2ican2@aol.com","10","19","74","M","6'","1""","180","no","250,000","Term","","","","","postponed","","5","diet and insulin","insulin injections","3 or more times/day","1 or 2 times/day","0-6 months","","","","","","","","","","","yes","7.6-10","yes","more than 24 months","","","","yes","7 times/week","stairs, walking, and strengthening","no","Relationship","","Relationship","","Relationship","","","Submit"
"GISELA PIEDRAS","300 CAPETOWN CT","NOVATO, CA, 94947","(415)897-5651","(415)897-5651","","(415)721-0995","WWW.GISPIEDRAS@HOTMAIL.COM","12","09","1984","F","4'","11""","98LB","no","","Survivor UL","","","","","declined","","9","diet and insulin","","insulin pump","3 or more times/day","0-6 months","","","","","","","","","","","yes","7.6-10","yes","0-6 months","","","","yes","3 times/week","WALKING OR RUNNING","no","Relationship","","Relationship","","Relationship","","","Submit"
"thomas king","8702 120th st ct e","puyallup wa 98373","253-848-1709","same as above","","","iak54@comcast.net","11","21","1954","M","5'","10""","200","no","200,000","Term","","","","","declined","","44","diet and insulin","","3 or more times/day","3 or more times/day","0-6 months","","","","","","yes","","","","","yes","7.6-10","yes","0-6 months","126/70","10","2004","yes","3 times/week","stairs, walking","no","Relationship","","Relationship","","Relationship","","","Submit"
"mary jane lopez","815 Illinois st","South Houston","713-943-9204","713-943-9204","832-816-0262","713-943-9194","lysiat@yahoo.com","05","12","58","F","5'","5""","271","no","100,000.","Survivor UL","Refugio Lopez","","","none","declined","","40","diet and oral","novlin insulin","1 or 2 times/day","1 or 2 times/day","0-6 months","","","","","","","","","","none above","no","7.6-10","yes","0-6 months","","","","no","5 times/week","home","no","Relationship","","Relationship","","Relationship","","","Submit"
"Mary Jane Lopez","815 Illinois st","South Houston Texas 77587","719-943-9204","713-943-9204","832-816-0262","713-943-9194","lysiat@yahoo.com","05","12","58","F","5'","2""","271","no","100.00","UL","Refugio Lopez","","","none","declined","","40","diet and oral","novlin insulin","1 or 2 times/day","1 or 2 times/day","0-6 months","","","","","","","","","","n/a","yes","above 13","yes","0-6 months","don't remember","10","04","yes","4 times/week","home ","no","Relationship","","Relationship","","Relationship","","","Submit"
"Chong Shoua Pha","6117 Ventura Street","Sacramento CA 95822","916-391-4105","770-655-3318","770-655-3318","","shygurlpa@hotmail.com","07","05","1940","M","5'","2""","190","yes","100000","Term","","08","2004","Global","declined","","63","diet and insulin","","insulin pump","1 or 2 times/day","0-6 months","","","","","yes","","","","","","no","select one","yes","0-6 months","","","","yes","3 times/week","walking","no","Relationship","","Relationship","","Relationship","","My dad goes to the Dialysis Clinic....
","Submit"
"Jason Nohr","824 Nob Ridge Drive","Marietta, GA  30064","404-271-4011","","","","jln@hn-law.com","07","04","1970","M","6'","0""","192","no","400,000","Term","","","","","declined","","34","diet and insulin","","3 or more times/day","3 or more times/day","0-6 months","","","","","","","","","","","yes","below 7.5","yes","0-6 months","100/70","10","04","yes","5 times/week","","no","Relationship","","Relationship","","Relationship","","I am in excellent health with excellent BP and lipid profile.  I have been actively and successfully treating my Type I diabetes since my August 2004 diagnosis ","Submit"
"Ty Fellers","","Little Mountain, SC, 29075","803-936-5973","","","","tyandconnie@yahoo.com","07","04","69","M","4'","6""","100","no","$300,000","Term","","","","","declined","","33","diet and insulin","","insulin pump","3 or more times/day","0-6 months","","","","","","","","","","","yes","below 7.5","yes","more than 24 months","117/72","07","04","yes","4 times/week","weight training and cardiovascular work","no","Relationship","","Relationship","","Relationship","","","Submit"
"PATRICK BLANCHARD","707 NORTH 7TH ST","THIBODAUX LA. 70301","985 580 3881","","","","PATRICK.BLANCHARD@DIGICON-INC.COM","04","26","69","M","5'","9""","150","yes","150000","Term","","","","","declined","","31","diet and insulin","","3 or more times/day","3 or more times/day","0-6 months","","","","","","","","","","","yes","10.1-13","yes","0-6 months","","","","yes","5 times/week","GYM","no","Relationship","","Relationship","","Relationship","","","Submit"
"Mark I Burch","212 Randolph Ave","Waynesboro, Virginia 22980","540-946-7873","540-946-7873","540-471-0078","","mibraf@yahoo.com","06","26","71","M","5'","10""","155","no","100000","UL","","","","","declined","","31","diet and insulin","","1 or 2 times/day","1 or 2 times/day","0-6 months","","","","","","","","","","","yes","below 7.5","no","0-6 months","","","","yes","2 times/week","weight lifting","no","Relationship","","Relationship","","Relationship","","","Submit"
"Mark I Burch","212 Randolph Ave","Waynesboro, Virginia 22980","540-946-7873","540-946-7873","540-471-0078","","mibraf@yahoo.com","06","26","71","M","5'","10""","155","no","100000","UL","","","","","declined","","31","diet and insulin","","1 or 2 times/day","1 or 2 times/day","0-6 months"Anthony Fagen","103 Darling St Flr 2","Central Falls, RI 02863","617-578-3940","401-726-7989","401-338-2422","617-933-7618","anthony_fagen@yahoo.com","12","09","66","M","5'","7""","200","no","500000","UL","","","","","declined","","22","diet and insulin","","1 or 2 times/day","3 or more times/day","0-6 months","","","","","","yes","","","","ED","yes","10.1-13","yes","0-6 months","120/80","09","04","yes","3 times/week","walking","yes","father","hemmorage","mother","sepsis","Relationship","","Parents each died at A61; take Glucophage 1000 mg 2x day as well as sliding scale Novolin R and N.","Submit"
"Nicholas A. Poplawski","11604 Dunn Rd","Riley Twp., MI  48041","810-384-8107","","","","poplawski@firststep.net","12","07","97","M","4'","3""","65","no","","Select one","","","","","declined","","6","diet and insulin","","3 or more times/day","3 or more times/day","0-6 months","","","","","","","","","","","yes","below 7.5","yes","0-6 months","","","","yes","select one","","no","Relationship","","Relationship","","Relationship","","","Submit"
"Andres Restrepo","8827 SW 123rd #305","Miami, Fl 33186","305-443-3339","305-598-2317","305-898-6153","","giants1401@hotmail.com","04","22","1971","M","5'","10""","201","no","50000.00","Term","","12","04","AFLAC","declined","","15","diet and insulin","","insulin pump","3 or more times/day","0-6 months","","","","","","","","","","","yes","below 7.5","yes","more than 24 months","125/81","10","04","yes","1 time/week","Cardiovascular","no","Relationship","","Relationship","","Relationship","","","Submit"
"Joe","Ford","Canton, MI","734-392-4275","","","","paremike@yahoo.com","11","20","1959","M","6'","5""","290","no","250,000","Term","","","","","declined","","45","diet","","insulin pump","1 or 2 times/day","0-6 months","","","","","","","","","","","yes","7.6-10","yes","0-6 months","130/60","12","2004","yes","5 times/week","Walking","no","Relationship","","Relationship","","Relationship","","","Submit"
"Erick Cortez","1801 N. Oxnard Blvd. 176","Oxnard CA 93030","805-485-5334","","","","trinityandsami@yahoo.com","10","15","1971","M","5'","8""","185","no","100000","Term","","","","","declined","","28","diet and oral","Glucovance","insulin pump","1 or 2 times/day","6-12 months","","","","","","","","","","","no","select one","yes","0-6 months","130 / 85","1","04","yes","5 times/week","jogging, walking, biking","no","Relationship","","Relationship","","Relationship","","I haven't had a cholesterol test for a while, but I've never been told I have a high reading despite numerous physical exams.","Submit"
"Roman Simkin","106 Bellewood Court","Macon, GA, 31210","478-277-9225","","","","rsimkin@cox.net","07","05","1954","M","5'","10""","214","no","200,000","Term","","","","","declined","","48","diet and oral","Metformin HCL","1 or 2 times/day","1 or 2 times/day","0-6 months","","","","","yes","","","","","","yes","below 7.5","yes","more than 24 months","120 over 70","11","04","yes","4 times/week","aerobics and weihts","no","Relationship","","Relationship","","Relationship","","","Submit"
"Devin","125 S. Tanninger Rd.","Mt. Holly, NC, 28120","7048271884","7048271884","7049746693","","brookewray@bellsouth.net","08","22","78","F","5'","3""","110","yes","","Select one","","","","","declined","","","diet","","insulin pump","1 or 2 times/day","0-6 months","","","","","","","","","","","yes","select one","yes","0-6 months","","","","yes","select one","","yes","Relationship","","Relationship","","Relationship","","","Submit"
"Devin","125 S. Tanninger Rd.","Mt. Holly, NC, 28120","7048271884","7048271884","7049746693","","brookewray@bellsouth.net","08","22","78","F","5'","3""","110","no","20,000.00","Term","","","","","declined","","24","diet","Novolog","3 or more times/day","3 or more times/day","0-6 months","","","","","","","","","","","no","select one","yes","0-6 months","","","","yes","3 times/week","walking","no","Relationship","","Relationship","","Relationship","","","Submit"