Diabetes Foot Exam Form PDF Details

A diabetes foot exam is an important part of managing your diabetes. This form can help you keep track of the results of your foot exams. You can use this form to discuss any concerns or problems you have with your doctor. Completed by: ____________________________ Date: ___________________________ Time: _____________________ Feet were inspected for color, temperature, pulses and sensation. Looked for redness, blisters, calluses, cuts and nails abnormalities. Check WNL (within normal limits) as appropriate. No Concerns/Issues detected today. Comments:____________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ Foot Exam Form PDF Version

QuestionAnswer
Form NameDiabetes Foot Exam Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesdiabetes foot exam form, annual foot exam form, diabetes foot exam form printable, diabetic foot exam form pdf

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ANNUAL COMPREHENSIVE DIABETES FOOT EXAM FORM

TOOLS

5. Vibration Perception with 128-Hz tuning fork

Check appropriate box. ! Normal (+)

! Abnormal (-)

! Socks

Wisconsin฀Diabetes฀Mellitus฀Essential฀Care฀Guidelines฀•฀2012

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