QHRFF item | Supporting tool or literature |
---|---|
General demographics* | [35] |
Indigenous status | [14] |
Health professionals attending* | |
Medical co-morbidity history* | |
Medical (diabetes) history | |
Diabetes year diagnosed (duration) | |
Recent BGLs > 15 mmol/L | |
HbA1c result | |
CKD | |
ESRF | |
High-risk factor history* | |
Clinical diagnoses of high-risk factors | |
Neuropathy | |
PAD | Foot pulses, ankle brachial index and/or toe systolic pressure [1, 14, 21, 22, 39, 46–49] |
Acute Charcot | |
Foot deformity | |
Risk classification | |
Clinical diagnoses of foot disease | |
(Ulcer) type | |
Combined surface area mm2 | |
Combined surface area (change since last visit) | |
Clinical signs of infection | |
UTWCS grade | |
Ulcer depth# | |
Clinical management principles performed* |