Get Ankle Brachial Index Assessment Form

The Ankle Brachial Index Assessment Form is a crucial document for evaluating vascular health. This guide provides step-by-step instructions to help you fill out this form accurately and efficiently online.

Follow the steps to successfully complete the Ankle Brachial Index Assessment Form.

1. Press the ‘Get Form’ button to access the Ankle Brachial Index Assessment Form and open it in your editor.
2. Enter the patient's name in the designated field labeled 'Patient Name'.
3. Input the patient's ID number in the 'ID Number' field.
4. In the 'Risk Factors' section, check off any applicable boxes that reflect the patient's health conditions, such as tobacco use, hypertension, diabetes, etc.
5. Record the patient's current age in the provided space.
6. If applicable, note any previous vascular surgeries in the designated area.
7. Enter the date in the 'Date' field.
8. In the 'ABI / Severity of Disease' section, select any relevant symptoms experienced by the patient, such as intermittent claudication or numbness.
9. For the 'Left ABI at the PT' and 'Right ABI at the PT' sections, enter the pressure measurements for the left and right arm, respectively.
10. Complete the 'Right ABI at the DP' and 'Left ABI at the DP' sections with the respective pressure readings.
11. Once all sections are completed, you can save your changes, download the document, print a physical copy, or share it as needed.

Complete the Ankle Brachial Index Assessment Form online to ensure accurate health assessments.