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Get Diabetes Foot Screen - Hrsa - Hrsa
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How to fill out the Diabetes Foot Screen - HRSA - Hrsa online
The Diabetes Foot Screen - HRSA - Hrsa is a crucial form designed to assess foot health for individuals with diabetes. This guide will provide you with detailed instructions on how to complete the form online accurately and effectively.
Follow the steps to fill out the Diabetes Foot Screen form.
- Click the ‘Get Form’ button to access the Diabetes Foot Screen form and open it in your document interface.
- Begin by filling in the patient's name (Last, First, MI) along with the date in the provided fields at the top of the form.
- In Section 1, respond to the twelve questions by indicating findings for the right foot (R) and left foot (L) using 'Y' for yes or 'N' for no in the respective blanks. Ensure to complete all entries.
- As you answer questions, consider the implications of each response. A history of foot ulcers or deformities can significantly categorize the risk level; take care to note any important observations.
- Proceed to Section 2, where you will detail any skin conditions. Accurately draw and label conditions identified, such as callouses or ulcers, directly on the foot diagrams provided.
- Perform a sensory exam using the 10-gram monofilament testing at the indicated locations on the foot drawings, and record the patient's responses in the designated circles.
- In Section 3, evaluate the patient's risk category based on your findings and mark it clearly on the form. Ensure that the assessment aligns with the criteria outlined in the guidance.
- Finally, fill out the section for the provider performing the screening, including their name and any relevant credentials, before concluding the form.
- Once all sections are complete, you can save your changes, download the document, print it for physical records, or share it as necessary.
Complete the Diabetes Foot Screen - HRSA - Hrsa online to ensure comprehensive foot health assessment.
A diabetic foot screening typically involves a comprehensive evaluation of both feet. Healthcare providers will check for any deformities, skin integrity, and circulation issues, along with assessing sensation using monofilament tests. The Diabetes Foot Screen - HRSA - Hrsa aims to ensure that all aspects of foot health are considered, allowing for timely interventions if necessary.
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