Get Pad Screening Questionnaire 2 Pg Revised-moosadocx

Filling out the PAD Screening Questionnaire 2 Pg REVISED-Moosadocx online can help you provide essential health information to your healthcare provider. This guide will walk you through each section of the form, ensuring you understand what is required.

Follow the steps to complete the PAD Screening Questionnaire online.

1. Click the ‘Get Form’ button to obtain the PAD Screening Questionnaire and open it in your document editor.
2. Start by entering your personal information at the top of the form. Fill in your name, date of birth, age, and today's date in the designated fields.
3. Indicate whether you have ever had your blood pressure tested in your ankle by selecting 'Yes' or 'No' and provide the approximate date if applicable.
4. Select your present age range by marking the appropriate option: '49 or less', '50-64', or '65 or older'.
5. Respond to the smoking questions by indicating your current status: whether you smoke, have quit, or quit at a specific age.
6. For the following questions, select 'Yes' or 'No' regarding diabetes, high blood pressure, high cholesterol, history of heart attack or stroke, and relevant surgeries.
7. Answer questions regarding leg pain when walking, pain at rest in your lower legs or feet, and foot or toe pain that disturbs your sleep.
8. Total your score from the answers specified in previous steps and document the total in the provided space.
9. Indicate if you have chronic kidney disease or end-stage renal disease by choosing 'Yes' or 'No' as applicable.
10. Stay informed about your score interpretation—note what your total score suggests regarding peripheral arterial disease.
11. Finally, review all your entries for accuracy and ensure the form is complete. You can then save changes, download, print, or share the completed form.

Complete the PAD Screening Questionnaire online to better understand your health!