Comprehensive Diabetes Foot Examamination Form 2009-2025 free printable template

Comprehensive Diabetes Foot Examination Form Adapted from the National Diabetes Education Program s Foot Screening Form Name: Date: Age at Onset: Diabetes Type I. Medical History (Check all that apply.)

How to fill out printable diabetic foot exam

How to fill out Comprehensive Diabetes Foot Examamination Form

1. Gather the necessary patient information, including name, age, and medical history.
2. Obtain consent from the patient for the examination.
3. Assess the patient's feet visually for any abnormalities such as sores, calluses, or foot deformities.
4. Measure the patient's foot pulses using a Doppler device to check blood flow.
5. Conduct a monofilament test to assess the patient's sensitivity to pressure in different areas of the foot.
6. Check for temperature differences between the two feet to identify possible circulation issues.
7. Document all findings on the Comprehensive Diabetes Foot Examination Form carefully.
8. Provide recommendations based on the findings, such as referrals to specialists or foot care education.

Who needs Comprehensive Diabetes Foot Examamination Form?

1. Individuals diagnosed with diabetes, particularly those with a history of foot ulcers or neuropathy.
2. Patients who have had previous foot problems or amputations.
3. Diabetic patients experiencing symptoms such as tingling or loss of sensation in their feet.
4. Individuals with poor blood circulation or those at risk of developing foot complications due to diabetes.

Video instructions and help with filling out and completing printable diabetic foot exam form

Instructions and Help about printable diabetic foot exam

Oh, my name is Colin Bristol, and I'm a fourth-year medical student you can ask your name please yeah it's Dennis Matthews okay Dennis now I understand you have diabetes I've been up sticks on your legs today that'll just involve me checking the sensation in your legs and checking some pulses in your legs and then watching you walk afterwards would that be all right yeah that's fine okay first if I could ask you to just lift your short supports alone that's excellent I'm just going to have a look at your legs from the end of the bed all right okay I'm just going to check for any hair loss any skin changes any redness or ulcers okay I'm just going to have a look between your tools dance all right okay I also check the bottom of your feet that's great can you lift your heel up I'm Delaney brilliant okay Dennis I'm just going to feel if your legs now that was just involve me feeling down your legs I'm feeling the pulses so all right okay Dennis I'm just going to have a feel of your tools now I'm just going to press gently on the bottom of them okay I'm now going to test the sensation in the bottom of your foot with this monofilament it feels like this, and again I'd like you to close your eyes and let me know if you can feel it on the left or the right hand side okay all right left okay I'd like to test vibration in your feet now and that's going to involve me placing this tuning fork on your feet with your eyes closed I'd like you to tell me if you feel the vibration and tell me when it stops right, so it normally feels like this okay all right so close your eyes yeah, and it's stopped yeah and I stopped you okay that I'm just going to test your sense of joint position now so with your toe this is up this is done you close your eyes and tell me whether it's going up or down okay Oh down go in Oh down okay Dennis I just like to test your reflexes now, so I'm just going to tap the back of your leg with this tendon hand we're just gently so alright yeah that's right okay could you just lift this knee up and flop the leg out to the side go in great okay Dennis I just like to watch you're walking out if you could come off the bed just walk on some fun okay Donuts slaps me finish my examination would you mind if I'd a quick look at your shoes just before you put them back on yeah let's find out okay all right that's going thank you very much for letting me examine you no problem so this was Dennis Matthews, and today I performed a diabetic foot examination with him on examination there was no new uh vascular deficit suggestive of diabetic disease I could complete the examination by performing a Phil neurovascular assessment measuring the capillary blood glucose at a bedside and advising Dennis on appropriate food care

People Also Ask about

What is the CPT code for foot exam?

This includes examination and diagnostic services associated with routine foot care performed in the absence of a localized illness, symptoms, or injury. These routine foot care services are defined and reported with the following procedure codes: 11055, 11056, 11057, 11719, 11720, 11721, G0127, and G0247.

What is a comprehensive diabetic foot exam?

The foot examination should include inspection, assessment of foot pulses, and testing for loss of protective sensation (10-g monofilament plus testing any one of: vibration using 128-Hz tuning fork, pinprick sensation, ankle reflexes, or vibration perception threshold).

When do you use G9226?

HCPCS code G9226 for Foot examination performed (includes examination through visual inspection, sensory exam with 10-g monofilament plus testing any one of the following: vibration using 128-Hz tuning fork, pinprick sensation, ankle reflexes, or vibration perception threshold, and pulse exam; report when all of the 3

How often can you bill diabetic foot exam?

You can get a foot exam once a year, as long as you haven't seen a footcare professional for another reason between visits.

How long does a diabetic foot exam take?

As you can see, a comprehensive diabetic foot exam a very simple examination, completely painless, and it takes about 20 - 30 minutes. If you have diabetes, making sure you get this exam every year is one of the most important things you can do to manage your diabetes and prevent amputations.

What is included in a diabetic foot exam?

Your provider will: Look for various skin problems, including dryness, cracking, calluses, blisters, and ulcers. Check the toenails for cracks or fungal infection. Check between the toes for signs of a fungal infection.

How to do a diabetic foot check?

Get to the bottom of any foot problems by using a mirror or asking for help. Check your feet every day for cuts, redness, swelling, sores, blisters, corns, calluses, or any other change to the skin or nails. Use a mirror if you can't see the bottom of your feet, or ask a family member to help.

What is the procedure code for diabetic foot exam?

Diabetic foot exam G9226 | Medical Billing and Coding Forum - AAPC.

What are the required elements of diabetic foot exam?

The clinical diabetic foot exam includes four major components: dermatological, vascular, neurological, musculoskeletal.

What are the components of diabetic foot exam?

The clinical diabetic foot exam includes four major components: dermatological, vascular, neurological, musculoskeletal.

What is a comprehensive foot examination for a diabetic patient?

Your provider will: Look for various skin problems, including dryness, cracking, calluses, blisters, and ulcers. Check the toenails for cracks or fungal infection. Check between the toes for signs of a fungal infection.

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What is Comprehensive Diabetes Foot Examination Form?

The Comprehensive Diabetes Foot Examination Form is a document used by healthcare providers to assess and document the condition of a diabetic patient's feet, helping to identify any potential issues such as neuropathy or poor blood circulation.

Who is required to file Comprehensive Diabetes Foot Examination Form?

Healthcare providers, particularly those managing diabetic patients, are required to file the Comprehensive Diabetes Foot Examination Form as part of routine diabetes care and management.

How to fill out Comprehensive Diabetes Foot Examination Form?

To fill out the Comprehensive Diabetes Foot Examination Form, the healthcare provider should assess the patient's feet thoroughly, document any findings related to foot structure, sensation, circulation, and history of foot ulcers or deformities, and then sign the form.

What is the purpose of Comprehensive Diabetes Foot Examination Form?

The purpose of the Comprehensive Diabetes Foot Examination Form is to establish a baseline for foot health in diabetic patients, facilitate early detection of foot complications, and monitor changes over time to prevent serious outcomes such as amputations.

What information must be reported on Comprehensive Diabetes Foot Examination Form?

The information that must be reported on the Comprehensive Diabetes Foot Examination Form includes patient demographics, clinical findings such as foot temperature, pulse, sensory perception, presence of ulcers or calluses, and any recommendations for treatment or follow-up care.