Get Diabetes Foot Screening Risk Stratification Form
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How to fill out the diabetes foot screening risk stratification form online
Filling out the diabetes foot screening risk stratification form online is an important step in assessing foot health for individuals with diabetes. This guide provides clear instructions on how to complete each section of the form to ensure that all necessary information is accurately captured.
Follow the steps to complete the form effectively.
- Click ‘Get Form’ button to access the form and open it in the editor.
- Fill in the patient details section, including the date, location, date of last screening, name, NHI, address, date of birth, type, age, treatment, and phone number. Ensure all information is accurate and complete.
- Complete the medical history section by providing details such as ethnicity, GP practice, and phone number. Indicate if the patient has diabetes type 1 or type 2, along with relevant clinical data like random BGL, CVD risk, renal eGFR, and creatinine levels.
- In the neurological testing section, answer yes or no to each question regarding loss of protective sensation and the palpation of relevant foot arteries. This helps to assess neuropathy and circulatory issues.
- Proceed to the risk factors section. Indicate yes or no for each item listed, including previous amputations, ulcerations, and significant deformities. Provide additional details if required.
- Detail the current foot status, indicating if there is active ulceration or foot disease. This will determine the urgency of action required.
- Determine the risk category for the patient based on the collected information. Make note of any actions that need to be taken based on the identified risk level, including referrals to specialists or education provided.
- Review all the information entered in the form for accuracy. Once verified, users can save changes, download, print, or share the form as necessary.
Complete your diabetes foot screening risk stratification form online today for better foot health management.
To perform a diabetic foot exam, follow a structured procedure that includes visual and sensory assessments. Inspect the feet for signs of injury, deformities, or changes in skin color. Conduct a sensory examination using a monofilament or tuning fork to assess nerve function. Incorporating the DIABETES FOOT SCREENING RISK STRATIFICATION FORM into this exam helps you document findings and determine the appropriate care plan for each patient.