Diabetes foot examamination form 2025

1. Click ‘Get Form’ to open the diabetes foot examination form in the editor.
2. Begin by entering your name and the date at the top of the form. Indicate your diabetes type by checking either box for Type 1 or Type 2.
3. In the Medical History section, check all applicable conditions such as Peripheral Neuropathy, Cardiovascular Disease, and others listed.
4. For Current History, answer questions regarding any changes in your feet since the last evaluation and any history of ulcers by selecting 'Yes' or 'No'.
5. Proceed to the Foot Exam section. Here, assess nail conditions and foot deformities, marking sensory levels with '+' or '-' as instructed.
6. Fill in pedal pulses by indicating present ('P') or absent ('A') for both posterior tibial and dorsalis pedis arteries.
7. In the Risk Categorization section, check whether you fall into low-risk or high-risk categories based on your responses.
8. Complete the Footwear Assessment by answering if appropriate shoes are worn and if inserts/orthotics are needed.
9. Finally, review Education and Management Plan sections to ensure all relevant information is filled out before signing.

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