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Diabetes Foot Screen Nam Last First MI Date Fill in the f llowing blanks with

R L Is there a history of a foot ulcer Is there a foot ulcer now Is there a claw toe deform ity Is there swelling or an abnorm l foot shape Is there elevated skin tem erature Is there lim ited ankle dorsiflexion Are the toenails long thi

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Diabetes Foot Screen Nam Last First MI Date Fill in the f llowing blanks with






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