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ANDRES BELLO

PODIATRIC RECORD
___________________________________________________________________ SEX: M F
FULL NAME IDENTITY
__________________________ DATE OF BIRTH : ___________________________ AGE: ___________
CARD
_____________________________________________________ PHONE: ______________________
ADDRESS
OCCUPATION
REFERRAL CENTER:

Diseases he suffers from:


DM HTA ARTHRITI OSTEOARTHRITIS OSTEOP.OTHERS: _______________________________
MEDICATIONS: S

WEIGHT: EXAMINATION OF THE FOOT:


PEDIAL PULSE TIBIAL PULSE POPLITEAL PROBL.
Kg. TEMPERATURE CIRCULATORY SKIN
PULSE POPLITEAL PULSE
STATURE:
m. Right Left Right Left Right Left Cold Normal Hot Yes No Dry Normal Wet

P / A: mHg FOOTWEAR: Suitable Inadequate Very inadequate

SYCHOLOGY MONOFILAMENT DIAGNOSIS

with abnormal monofilament test

Other recommended sites

REMARKS:
REMARKS:

TREATMENT
Asepsis Helotomy REMARKS
Promotion Devastated
Groove cleaning Polishing
Onychotomy Final Asepsis
Despiculization Others
Resectioning
INDICATIONS

DATE: _____ / _____ / ________


Name and signature of the
Professional

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