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DPMPD160105 Comprehensive Diabetic Foot Exam & Shoe Order Form Required to satisfy Medicare requirement of unperson visit to determine need for shoes. Complete form for ordering shoes and inserts

How to fill out comprehensive diabetic foot exam

How to fill out a comprehensive diabetic foot exam:

1. Begin by assessing the patient's medical history and any known diabetes-related complications. This includes identifying factors such as duration of diabetes, previous foot ulcers or amputations, neuropathy or peripheral arterial disease, and any diabetic nephropathy.
2. Perform a thorough visual inspection of the feet, looking for any signs of deformities, skin integrity issues, swelling, calluses, redness, or ulcerations. Pay attention to pressure points and bony prominences.
3. Test for neuropathy by using a monofilament or tuning fork to assess the patient's ability to perceive sensations in different areas of the foot. Document any areas with reduced or absent sensation.
4. Evaluate blood flow to the lower extremities by assessing pedal pulses and using a handheld Doppler to detect any abnormalities or indications of peripheral arterial disease.
5. Examine the patient's footwear and educate them on appropriate shoe choices and foot care practices. Provide recommendations for specialized footwear or orthotics if necessary.
6. Assess the patient's gait and mobility, observing for any abnormalities or difficulty in walking. This can help identify potential issues with balance, foot function, or joint problems.

Who needs a comprehensive diabetic foot exam:

1. Individuals with diabetes, particularly those with a history of foot ulcers, amputations, or other diabetes-related complications.
2. Patients with diabetic neuropathy or peripheral arterial disease.
3. Those who have had diabetes for an extended period or have difficulty managing their blood sugar levels.
4. Individuals with other risk factors such as obesity, high blood pressure, dyslipidemia, smoking, or a family history of foot complications.

It is important for healthcare professionals to conduct comprehensive diabetic foot exams regularly to identify potential foot complications early on, provide appropriate interventions, and educate patients on proper foot care to prevent further complications.

For pdfFiller’s FAQs

What is comprehensive diabetic foot exam?

A comprehensive diabetic foot exam is a thorough evaluation of the feet and lower extremities to assess for any signs of diabetes-related complications.

Who is required to file comprehensive diabetic foot exam?

Healthcare professionals who are treating patients with diabetes are required to conduct and file comprehensive diabetic foot exams.

How to fill out comprehensive diabetic foot exam?

Comprehensive diabetic foot exams can be filled out by conducting a physical examination of the feet and lower extremities, assessing for neuropathy, vascular issues, and any signs of infection or ulceration.

What is the purpose of comprehensive diabetic foot exam?

The purpose of a comprehensive diabetic foot exam is to prevent and detect early signs of diabetes-related foot complications such as neuropathy, ulcers, and infections.

What information must be reported on comprehensive diabetic foot exam?

Information such as the patient's medical history, findings from the physical examination, any abnormalities detected, and recommended treatment plan must be reported on a comprehensive diabetic foot exam.

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