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Get Uphp Annual Diabetes Foot Exam Form 2006-2026
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How to fill out the UPHP Annual Diabetes Foot Exam Form online
Filling out the UPHP Annual Diabetes Foot Exam Form online is a vital step in managing a person's diabetes and maintaining foot health. This guide will provide clear, step-by-step instructions to help users complete the form accurately and effectively.
Follow the steps to complete the online form.
- Click ‘Get Form’ button to obtain the form and open it in the appropriate editing platform.
- Begin by entering the user's name, date of birth (DOB), and medical record number (MR#) in the designated fields.
- Indicate any history of amputation by specifying right or left, if applicable.
- Note the history of ulceration for both feet. For each foot, check 'No' or 'Yes' and provide the date of the ulceration if applicable.
- Assess whether the user is able to see the bottom of their feet and if they are wearing properly fitting shoes by selecting the appropriate 'Yes' or 'No' options.
- Complete the foot exam section by checking the relevant boxes for findings such as foot ulcers, abnormal shapes, or callus build-up for each foot.
- Proceed to the Peripheral Artery Disease (PAD) screen section, where users should indicate if there is a history of claudication and if pedal pulses are present.
- Fill in any notes or comments regarding the examination observations in the provided fields.
- Complete the Ankle Brachial Index (ABI) results section by marking 'Yes' or 'No' and entering the results if applicable.
- Indicate if a referral was made, including details about the appointment date and exam date.
- Finally, the user or examiner must sign the form to validate the entries.
- Once all fields are completed, users can save changes, download the form, print it, or share it as needed.
Complete the UPHP Annual Diabetes Foot Exam Form online today to support effective diabetes management.
Medicare usually covers diabetic foot care if you meet certain criteria, including having any diabetes-related complications. Generally, patients can receive covered diabetic foot care services up to twice a year. Utilize the UPHP Annual Diabetes Foot Exam Form to keep track of your appointments and eligibility for Medicare coverage related to foot health.