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ARFC Findings:
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Class A Findings:
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Amputation Location:
• • •
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Additional Comments:
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Class B Findings:
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Left DP Absent?
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Right DP Absent?
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Left PT Absent?
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Right PT Absent?
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Subset Class B Findings:
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Thin/Shiny Atrophic Skin?
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Decreased/Absent Hair Growth
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Pigmentary Changes?
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Skin Color (Rubor/Red)
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Thick Nails?
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Class C Findings:
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Cold feet/legs / increased temp. gradient?
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Paresthesias?
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Edema?
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Burning?
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PCP
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Date of last PE
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PCP Contact Information
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Comments
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Edinburgh Claudication:
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Leg pain when walking?
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pain begins when standing still?
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Pain when walking uphill in a hurry?
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Pain during ordinary pace on level?
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Pain for 10+ min when stationary?
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Claudication Location Image:
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