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Tools Wisconsin Diabetes Mellitus Essential Care Guidelines • 2012 60 ANNUAL COMPREHENSIVE DIABETES FOOT EXAM FORM 5. Vibration Perception with 128-Hz tuning fork Check appropriate box. ! Normal (+) ! Abnormal (-) ! Socks

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Page 1: ANNUAL COMPREHENSIVE DIABETES FOOT … Comprehensive Diabetes Foot Exam Form c- Name: l. Presence of Diabetes Complications 1. Check all that apply. Peripheral Neuropathy Nephropathy

ToolsWisconsin Diabetes Mellitus Essential Care Guidelines • 2012

60

ANNUAL COMPREHENSIVE DIABETES FOOT EXAM FORM

5. Vibration Perception with 128-Hz tuning fork Check appropriate box. ! Normal (+) ! Abnormal (-)

! Socks

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