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Always on
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left/right foot/ankle
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Forefoot
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left
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Bunions
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Hammertoes
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Bunionette
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Fungal Nails
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Left Metatarsalgia
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which meatarsal
• • •
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ingrown nail
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Digit
• • •
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Soft tissue mass
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Where
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Pain at MPJ
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Which one
• • •
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Callus present
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Where
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Fracture
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Where
• • •
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Pain present for
• • •
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Type of pain
• • •
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Severity of pain
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aggravating factors
• • •
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prior events
• • •
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Previous treatments
• • •
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affectiveness of previous treatments
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New Short Text Field
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Right
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Bunions
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Hammertoes
• • •
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Bunionette
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Fungal Nails
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Right Metatarsalgia
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which meatarsal
• • •
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ingrown nail
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Digit
• • •
|
|
Soft tissue mass
|
Where
• • •
|
|
Pain at MPJ
|
Which one
• • •
|
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Callus present
|
Where
• • •
|
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Fracture
|
Where
• • •
|
|
Pain present for
• • •
|
Type of pain
• • •
|
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Severity of pain
|
aggravating factors
• • •
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prior events
• • •
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Previous treatments
• • •
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affectiveness of previous treatments
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New Short Text Field
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midfoot
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Left
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Where
• • •
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Callus present
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Deformity present
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Bony exostosis
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Fracture
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since when
• • •
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Pain present for
• • •
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Type of pain
• • •
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Severity of pain
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aggravating factors
• • •
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Previous treatments
• • •
|
affectiveness of previous treatments
|
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Right
|
Where
• • •
|
|
Callus present
|
Deformity present
|
|
Fracture
|
since when
• • •
|
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Bony exostosis
|
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Pain present for
• • •
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Type of pain
• • •
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Severity of pain
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aggravating factors
• • •
|
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Previous treatments
• • •
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affectiveness of previous treatments
|
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Rearfoot
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Left
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Where
• • •
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which part
• • •
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Fracture present
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Where
• • •
|
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since when
• • •
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|
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Deformity present
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what kind
• • •
|
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Pain present for
• • •
|
Type of pain
• • •
|
|
Severity of pain
|
aggravating factors
• • •
|
|
Previous treatments
• • •
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affectiveness of previous treatments
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right
|
|
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Where
• • •
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which part
• • •
|
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Fracture present
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Where
• • •
|
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since when
• • •
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|
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Deformity present
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what kind
• • •
|
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Pain present for
• • •
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Type of pain
• • •
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Severity of pain
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aggravating factors
• • •
|
|
Previous treatments
• • •
|
affectiveness of previous treatments
|
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Ankle
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Left
|
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Where
• • •
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which part
• • •
|
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Fracture present
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Where
• • •
|
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since when
• • •
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|
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Deformity present
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what kind
• • •
|
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Pain present for
• • •
|
Type of pain
• • •
|
|
Severity of pain
|
aggravating factors
• • •
|
|
Previous treatments
• • •
|
affectiveness of previous treatments
|
|
Right
|
|
|
Where
• • •
|
which part
• • •
|
|
Fracture present
|
Where
• • •
|
|
since when
• • •
|
|
|
Deformity present
|
what kind
• • •
|
|
Pain present for
• • •
|
Type of pain
• • •
|
|
Severity of pain
|
aggravating factors
• • •
|
|
Previous treatments
• • •
|
affectiveness of previous treatments
|
|
Warts
|
|
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Left
|
Right
|
|
since when
• • •
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since when
• • •
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Previous treatments
• • •
|
Previous treatments
• • •
|
|
affectiveness of previous treatments
|
affectiveness of previous treatments
|
|
Severity of pain
|
Severity of pain
|
|
Previous pod/ortho/docs seen
|
New Free Draw
|
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Gout
|
|
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Left
|
|
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Location
• • •
|
|
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Duration
|
|
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Previous history
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Current medication
• • •
|
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How often
|
Severity of pain
|
|
Right
|
|
|
Location
• • •
|
|
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Duration
|
|
|
Previous history
|
Current medication
• • •
|
|
How often
|
Severity of pain
|
|
Clinical Image
|
|
|
Podiatrist seen previously?
|
|
