Get Printer-friendly Foot Evaluation Form - Hrsa - Hrsa

Filling out the Printer-friendly Foot Evaluation Form - HRSA - Hrsa can be an essential step in evaluating foot health and needs. This guide provides a detailed, step-by-step approach to completing the form accurately and efficiently, ensuring that all necessary information is collected.

Follow the steps to successfully complete the form:

1. Press the ‘Get Form’ button to obtain the foot evaluation form and open it for editing.
2. Begin by filling out the personal information section. Enter the user's name, age, ID number, and date.
3. In the diagnosis section, indicate whether the condition is unilateral (LL), bilateral (BL), or total limb (TL) and mark any relevant medical conditions such as diabetes, peripheral vascular disease (PVD), or venous insufficiency.
4. Provide a medical history including whether the person has experienced a foot ulcer and describe the ulcer's location if applicable.
5. If the individual has undergone any foot surgeries, check 'Yes' and provide a detailed description.
6. In the complaints section, note any changes in the foot over the past year.
7. Indicate employment status and describe the job, alongside the current residence information.
8. Complete the deformity assessment by evaluating the range of motion (ROM) and muscle strength (MMT) for both the left and right foot.
9. Assess vascular status for both feet by indicating any issues such as dysmorphism.
10. Evaluate plantar sensation by noting the sensory level for right and left feet.
11. Select the appropriate foot risk category based on the W.H.O. grading system.
12. Document any clinical appearance of the skin using the provided labeling system.
13. Record any nerve palpation findings if present.
14. In the plan section, check all relevant patient education and interventions needed.
15. Finally, review all entries for accuracy before saving changes. You may also download, print, or share the completed form.

Complete the Printer-friendly Foot Evaluation Form - HRSA - Hrsa online to ensure thorough documentation of foot health.