Follow-Up Podiatry Progress Note

Date of Service:______Facility:______Room #:______Patient:______SEX:___ Attending:______DLV:______Date of Birth:______Allergies:______Responsive Capacity:  Good  Fair  Poor  Combative Place of service:  Bedside Wheelchair Patient is  ambulatory  Bedridden Clinical Findings

Vascular Exam R L Orthopedic Exam R L Hammer Toes? 1 2 3 4 5 1 2 3 4 5 Dorsalis Pedis /4 /4 Clavi/Callous 1 2 3 4 5 1 2 3 4 5 Posterior Tibialis /4 /4 Bunion?  Yes  No  Yes  No Popliteal Pulse /4 /4 Overall ROM:  WNL  WNL Capillary Filling Time _____sec ____sec  Decreased  Decreased Varicosities  Foot Foot Crepitus/effusion?  Yes  No  Yes  No  Ankle Ankle Amputation? TOE___ BKA___ TOE___ BKA___  Leg Leg TMA___ AKA___ TMA___ AKA___ Temp. Gradient  WNL  WNL INC/DEC INC/DEC Skin Temperature  WNL  WNL Cool/Hot Cool/Hot Edema  Yes  NO  Yes  No (Location) ______Hair growth  Yes  NO Yes  No  Diminished  Diminished Dependant Rubor/Pallor/Cyanosis?  Yes  No Yes  NO Dermatological Exam Skin Color  Normal  Cyanotic R L B PODIATRIC DIAGNOSIS (ES)  Ruborous  Pallor Texture  Normal  Thin R L B 1)______2) ______Atrophic Skin Lesions 3)______4) ______ Hyperkeratoses ______ Preulcerative Area______ Ulcerations______ Other______Podiatrist’s Notes: Interspaces R L ______ Clear 1 2 3 4 5 1 2 3 4 5 ______ Macerated 1 2 3 4 5 1 2 3 4 5 ______Nails Treatment Plan: 1 2 3 4 5 1 2 3 4 5  Normal  Hypertrophic Dystrophic  Discoloration  Thickening  Thick,Yellow, Mycotic  Onochocryptosis  Lateral nail border  Medial Nail Border  Both Borders  Drainage  Evidence of clubbing  Evidence of pitting

______ 60 days  90 days  Next Visit Podiatrist’s Signature Date C/O: “______”

/podiatry/Podiatry Progress Note Oct.98