Get Annual Comprehensive Diabetes Foot Exam Form - Ndep Nih

Filling out the Annual Comprehensive Diabetes Foot Exam Form - Ndep Nih online is an essential step in managing diabetes care. This guide provides clear, step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to effectively complete the form.

1. Press the ‘Get Form’ button to access the form and open it in the editor.
2. Begin by entering the patient's name, date, and identification number in the designated fields at the top of the form.
3. In section I, indicate the presence of any diabetes complications by checking all applicable boxes, including peripheral neuropathy and nephropathy.
4. Answer yes or no to the questions about any changes in the foot since the last evaluation, shoe problems, presence of blood or discharge, and smoking history.
5. Record the most recent hemoglobin A1c result and the date in the specified fields.
6. In section II, indicate if there is pain in the calf muscles when walking by responding yes or no.
7. For the current history, fill in the shoe-related details and other findings regarding the patient’s nails.
8. In section III, document the skin, hair, and nail condition using yes or no responses.
9. Label the patient's skin condition using the designated symbols (e.g., C for callus, U for ulcer) in the foot diagram provided.
10. Assess and record musculoskeletal deformities of the foot, checking any applicable boxes.
11. Fill in the pedal pulses, noting whether they are present or absent in the appropriate blanks for both feet.
12. Conduct the sensory foot exam and label the sensory level with '+' or '-' in the marked areas.
13. In section IV, categorize the risk by checking the appropriate box for either low risk or high risk, depending on the findings.
14. Evaluate the footwear assessment by indicating yes or no for each question regarding appropriate footwear and inserts.
15. In the education section, indicate yes or no for the patient's prior foot care education and capabilities.
16. Complete the management plan by checking all relevant boxes and providing any necessary dates for education or referrals.
17. Finally, ensure all information is complete, review the form, and then save changes, download, print, or share the completed form as needed.

Complete your documents online to ensure comprehensive foot care management.