Annual Comprehensive Diabetes Foot Exam Form Diabetes Foot Exam: Fill out & sign online

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Click ‘Get Form’ to open the Annual Comprehensive Diabetes Foot Exam Form in the editor.
Begin by entering the patient's name, date, and ID number at the top of the form. This information is essential for proper identification.
In Section I, check all applicable diabetes complications. This helps in assessing the patient's overall foot health.
Proceed to Section II and answer questions regarding any changes in foot condition since the last evaluation, shoe problems, and smoking history by marking 'Y' for yes or 'N' for no.
In Section III, evaluate skin, hair, and nail conditions. Use 'Y' or 'N' to indicate findings and measure any skin conditions as instructed.
Complete Sections IV through VII by categorizing risk levels, assessing footwear needs, providing education details, and outlining a management plan based on patient needs.

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