second Diabetic Foot Screen “7s 38 snc ENING TOOL Glvician Signature: {ntact aed healthy aby with Fungus eight calls frevy cals bud up oper aeration or History of previous ulcer Date io el-tept nem and ragged ‘id, damaged or infected emi so detcnity tmild deferty raajr deformity appropiate inappropriate ‘causing trauma, ature = Cold eck wars foot ts cla perature - Het Reet is ware fe of Motion Biuange to baln fal mis ileus LO ses detectee 1 to9 stes detected 2106 sites detected your fet ever numb? hey ever tingle? hey over burn? hey ver fel ke insects ar crawling on then? roto al questions esto any of the questions lat Puleee recent dosent Dendent Rubor ~ rs them es 1m fr foot ulcers and/or linb- threatening complication. Use the Highest score from left or right foot. += 006 recommend screening yearly Score = 7 to 1259 recommend screning every 6 months