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Diabetic Clinical Foot Exam
Diabetic Clinical Foot Exam

Diabetic Clinical Foot Exam

Part Number:Diabetic Clinical Foot Exam
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Use this template to make your clinical exam. Copy and paste into the above boxes. Add and subtract your own findings on your patient. If you already have a note from your EMR sinply copy and paste it in the EMR box.
Subjective: Patient returns to office for diabetic foot exam and diabetic shoes and inserts.
Objective:  Dystrophic, mildly, discolored nails 1-10X. Nails have sub ungual debris and cause pain with shoegear. Pulses both feet 1/4 both posterior tibial and dorsalis pedis. CFT wnl both feet. Diminished hairgrowth both feet and legs. 
Gross neurological exam wnl. Sharp/dull wnl both feet distally using a 5.07 Semmes Weinstein monofilament wire. Vibratory sense wnl both feet.  
Assesment: Diabetes poor circulation both feet. 
Plan: Order diabetic shoes and 3 pairs of custom inserts. Patient meets qualifications due to poor circulation. Custom inserts casted for today using impression foam. Custom inserts better for this patient to help offload the trouble area of his feet. Both feet measured a 10 wide. The patient will receive the shoes when all the paperwork is filled out by his PCP. 

Return to office 9 weeks for continued diabetic foot care. 


Dr. Jones agrees with this exam and that the patient qualifies for a pair of diabetic shoes and inserts. 


 Joe Smith  DPM                                                  Date Signed


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Seth Jones MD                                                     Date Signed


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