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Get Comprehensive Diabetes Foot Examamination Form

Check all that apply.) â–¡ Peripheral Neuropathy Age: Current Treatment: â–¡ Diet â–¡ Oral â–¡ II. Current History 1. Any change in the foot or feet since the last evaluation? â–¡ Yes â–¡ No 2. Current ulcer or history of a foot ulcer? â–¡ Yes â–¡ No 3. Is there pain in the calf muscles when walking that is relieved by rest? â–¡ Yes â–¡ No â–¡ Cardiovascular Disease â–¡ Nephropathy â–¡ Retinopathy â–¡ Peripheral Vascular Disease III. Foot Exam IV. Sensory Foot Exam 1. Are the nails th.

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