Get the free DIABETIC FOOT SCREEN*

Publication #45-12000 DIABETIC FOOT SCREEN* NO Acute swelling and/or Acute deformity ................... Skin breakdown (ulcer):................................... Callus with deeper color changes

How to fill out diabetic foot screen

To fill out a diabetic foot screen, you can follow the steps below:

1. Begin by gathering the necessary information such as the patient's demographic details, medical history, and any known risk factors for the development of diabetic foot complications.
2. Perform a thorough examination of the patient's lower extremities, paying close attention to any existing wounds, ulcers, or areas of redness. Assess the sensation in their feet using a monofilament or tuning fork, as reduced sensation can be indicative of peripheral neuropathy.
3. Measure the patient's blood pressure to evaluate their vascular status, as individuals with diabetes are at higher risk of developing peripheral arterial disease (PAD). Additionally, you may check the pulses in their feet to assess the adequacy of blood flow.
4. Inspect the patient's footwear and educate them about proper foot care and the importance of wearing appropriate shoes to prevent injuries and complications.
5. Finally, document your findings, including any abnormalities or areas of concern, in the diabetic foot screen form.

As for who needs a diabetic foot screen, it is recommended for individuals with diabetes, particularly those who have one or more of the following risk factors:

1. Long-standing history of diabetes
2. Poorly controlled blood sugar levels
3. History of foot ulcers or previous amputation
4. Peripheral neuropathy or loss of sensation in the feet
5. Peripheral arterial disease or impaired blood flow to the lower extremities
6. Foot deformities or abnormalities
7. Aging individuals with diabetes, as they are at increased risk of developing foot complications.

Regular screening for diabetic foot issues can help identify problems early on, allowing for timely intervention and prevention of potentially serious complications such as foot ulcers and amputations.

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What is diabetic foot screen?

Diabetic foot screen is a medical examination specifically designed to assess and monitor the foot health of individuals with diabetes.

Who is required to file diabetic foot screen?

Individuals with diabetes are required to undergo and file diabetic foot screening.

How to fill out diabetic foot screen?

Diabetic foot screen forms can be filled out by providing the required information such as personal details, medical history, foot assessment findings, and any recommended interventions or treatments.

What is the purpose of diabetic foot screen?

The purpose of diabetic foot screen is to identify potential foot complications related to diabetes, monitor foot health, and implement necessary interventions to prevent or manage complications.

What information must be reported on diabetic foot screen?

Diabetic foot screen forms typically require information such as patient demographics, medical history, foot assessment findings, any existing foot complications, and recommended treatments or interventions.