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Click ‘Get Form’ to open the lower leg assessment form in the editor.
Begin by entering the 'Date of assessment' and 'Location of assessment' at the top of the form.
In the 'SOCIAL HISTORY' section, fill in your occupation and indicate your living situation by checking the appropriate boxes.
For 'HISTORY OF LEG ULCERS', specify if there is a previous history of leg ulcers and provide details such as year of first occurrence and current ulcer onset date.
Complete the 'HEALTH HISTORY' section by checking any relevant medical conditions that may be associated with vascular disease.
In the 'MEDICATIONS' section, indicate any medications prescribed for leg/foot pain and note any allergies.
Proceed to fill out the 'LOWER LEG ASSESSMENT' fields, documenting signs of venous disease, arterial issues, and diabetic neuropathy as applicable.
Finally, review all sections for accuracy before saving or sharing your completed form using our platform's features.
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We are interested in knowing whether you are having any difficulty at all with the activities listed below because of your lower limb. Problem for which you areRead more
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