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PERIPHERAL ARTERY DISEASE (PAD) TESTING
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PAD TEST INDICATORS
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1. Do you experience any pain in your legs or feet while at rest?
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2.Do you have uncomfortable aching, fatigue, tingling, cramping or pain in your feet, calves, buttocks, hip/thigh during walking
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3. If Yes, to does the pain go away when you stop walking/exercising?
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4. Do your feet get pale, discolored or bluish at any time during the day?
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5. Do you have an infection, skin wound or ulcer on your leg or foot that is slow to heal over the past 8-12 weeks?
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6. Do you take any cholesterol medication?
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7. Do you have high blood pressure of take medication to reduce blood pressure?
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8. Do you have diabetes?
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9. Do you have a history of chronic kidney disease?
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10. Do you currently or have you ever smoked?
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11. Do you have a history of stroke or mini-stroke (TIA)?
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12. Do you have a history of heart disease (heart attack, MI)?
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13. Do you have a history of carotid stenosis, AAA (abdominal aortic aneurysm), and/or stent placement?
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PAD Screening Indicators
• • •
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QUANTAFLO TEST (Do not use this section for PADCHEK)
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QUANTAFLO TEST COMPLETED, CLICK ON
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QFLO-Right Foot Result
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QFLO Left Foot Result:
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QFLO Right Foot Value
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QFLO Left Foot Value
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Notes
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QuantaFlo Results
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PADCHEK TEST RESULTS
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PADCHEK TEST COMPLETED, CLICK ON
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PADCHEK Right ABI Value
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PADCHEK Left ABI Value
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PADCHEK Right ABI Results
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PADCHEK Left ABI Results
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DIABETIC FOOT EXAM - MONOFILAMENT TEST
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Right Foot Result
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Left Foot Result
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DPN TEST - Applecare Only
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DPN Test Conducted
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DPN Test Results
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