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Relevant History
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Remarks
• • •
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Relevant History
• • •
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NO CHANGE FROM LAST VISIT
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Comments
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Painful Lesions
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Corns - Painful
• • •
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Debride Corn per S/P
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Callus - Painful
• • •
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Debride Callus per S/P
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IPK-Painful Enucleated Keratosis
• • •
|
Please select
• • •
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NAIL PLATE
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At-Risk Routine Foot Care
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All Nails
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Left Foot
• • •
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Right Foot
• • •
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Billing Codes
• • •
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Needs location and size
|
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Corn
|
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Dx of Mycotic Nail
• • •
|
Callus
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MYCOTIC NAILS
|
Comments
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|
Clinical evidence of mycosis
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|
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Pain due to the mycotic nail
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Marked limitation of ambulation
|
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If left untreated
|
Secondary infection
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Comments
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CLASS FINDING FOR VASC COMPROMISED PATIENT
• • •
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Pulses
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|
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DP - Right
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DP - Left
|
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PT - Right
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PT - Left
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Pop - Right
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Pop - Left
|
|
Fem - Right
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Fem - Left
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Rad - Right
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Rad - Left
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Painful Ingrown Nails
|
R2
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Paronychia / Inflammed
|
R4
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Wedge Resection w/o Anesthesia
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R1
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L2
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R3
|
L4
|
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R5
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L1
|
|
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L3
|
R2
|
|
L5
|
R4
|
|
Fungal/Deformed/Dystrophic
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|
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R1
|
L2
|
|
R3
|
L4
|
|
R5
|
|
|
L1
|
Please select: 3 required
• • •
|
|
L3
|
UPIN
|
|
L5
|
|
|
CLASS B FINDINGS
• • •
|
CLASS C FINDINGS
• • •
|
|
Primary Care Doctor - Name
|
Systemic Conditions Justifying Routine Foot Care
• • •
|
|
Date Last Seen (within 6 months)
|
Plan
• • •
|
|
CLASS A FINDINGS
• • •
|
Questions
• • •
|
|
Diagnosis of Routine Foot Care
• • •
|
Plan
|
|
Assessment
• • •
|
|
|
Assessment
|
Paring ASx corn or callous
• • •
|
