UPHP Annual Diabetes Foot Exam Form 2006-2025 free printable template

Title: Microsoft Word Annual Foot exam Int 73pg2.doc Author: dkinnunen Created Date: 2/27/2006 11:56:43 AM

How to fill out diabetic foot exam documentation form

How to fill out UPHP Annual Diabetes Foot Exam Form

1. Obtain the UPHP Annual Diabetes Foot Exam Form from your healthcare provider or the UPHP website.
2. Fill in patient identification information including name, date of birth, and contact details.
3. Include relevant medical history, specifically any previous foot problems or diabetes-related issues.
4. Record current medications, especially any that affect blood circulation or nerve health.
5. Document foot exam results, detailing any abnormalities such as cuts, sores, or infections.
6. Check for circulation and sensation in both feet using standard examination techniques.
7. Indicate the date of the exam and sign the form.
8. Submit the completed form to the healthcare provider or keep it for your records.

Who needs UPHP Annual Diabetes Foot Exam Form?

1. Individuals diagnosed with diabetes who require annual foot examinations to monitor their foot health.
2. Patients with a history of foot ulcers or infections due to diabetes.
3. Anyone with neuropathy or other complications stemming from diabetes affecting the feet.
4. All diabetic patients as a preventive measure to avoid serious foot complications.

People Also Ask about diabetic foot examination pdf

How do you do a diabetic foot check?

3:22 5:01 Diabetic Foot Examination - OSCE Guide (Latest) - YouTube YouTube Start of suggested clip End of suggested clip Like. So and the same on the other. Side. That's the end of the examination. Thank you very much.MoreLike. So and the same on the other. Side. That's the end of the examination. Thank you very much.

What is a normal monofilament test result?

The normal monofilament was 2 g (Filament Index Number (FIN) 4·31) for the radial cutaneous and 4 g (FIN 4·56) for the sural nerve, although heavy manual laborers demonstrated a threshold of 10 g (FIN 5·07) for the sural nerve.

How can I do a diabetic foot exam at home?

Look for cuts, bruises, blisters, discoloration, callus build-up, or anything abnormal. Check between toes – Inspect between each of your toes for small injuries and skin changes as well. Feel for changes – Run your hands over your feet to feel for changes you might not see easily, like lumps, bumps, and cold spots.

What is normal sensation to monofilament?

Monofilament testing must be carried out in a quiet/relaxed setting to allow the client to fully participate in the test. normal sensation is expected, (e.g., hand). Doing the demonstration n the client's hands allows the client to experience the feeling before the test is done on their feet. 3.

What is included in a diabetic foot exam?

During a diabetic foot exam, your doctor will check for signs of infection, injury, bone abnormalities, nerve damage (neuropathy), and poor circulation (blood flow). Neuropathy and poor circulation are the two most common foot conditions people with diabetes have. Neuropathy can make your feet feel tingly or numb.

How do you document a monofilament test?

Record the results on the screening form, noting a “+” for sensation felt, and a “-” for no sensation felt. The patient is said to have an insensate foot if they fail on retesting at just one or more sites on either foot. Injury is much more likely to occur in these insensate areas and we must take protective measures.

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What is UPHP Annual Diabetes Foot Exam Form?

The UPHP Annual Diabetes Foot Exam Form is a document used by healthcare providers to assess and record the condition of a diabetic patient's feet during an annual examination.

Who is required to file UPHP Annual Diabetes Foot Exam Form?

Healthcare providers who are treating patients with diabetes are required to file the UPHP Annual Diabetes Foot Exam Form for their patients.

How to fill out UPHP Annual Diabetes Foot Exam Form?

To fill out the UPHP Annual Diabetes Foot Exam Form, providers must gather patient information, perform a thorough foot examination, record findings, and sign the form to validate the assessment.

What is the purpose of UPHP Annual Diabetes Foot Exam Form?

The purpose of the UPHP Annual Diabetes Foot Exam Form is to document the patient's foot health, identify potential problems early, and ensure proper management to prevent complications from diabetes.

What information must be reported on UPHP Annual Diabetes Foot Exam Form?

The information that must be reported on the UPHP Annual Diabetes Foot Exam Form includes patient demographics, examination findings, any foot deformities, circulation issues, and recommendations for further care if necessary.