PODIATRISCHE KRANKENAKTE INFORMATIONSBLATT Nr.

____

Vollständiger Name:
_______________________________________________________________________________Sexo:________
Address : ____________________________________________________________________________________________
Phone : __________________________Birth:____________________________ Age:_____________________
Occupation :____________________________________________________________________________________________
Centro de derivación:__________________________________________________________________________________________

Krankheit, an der er leidet:

XD HTA Arthritis Arthrose Osteopr Sonstige:__________________________________
Medicines :___________________________________________________________________________________________
SYMBOLOGIE Gewicht : _______kilos

Höhe :_______mt

Nr. Schuhe :________

FUSSUNTERSUCHUNG

PEDALIMPULS (+) (-)

Rechts Links

TIBIA-PULS (+) (-)

Rechts Links

TEMPERATUR

Kalt Norm Heiß

DURCHBLUTUNGSSTÖRUNGEN

Ja Nein

HAUT

trocken normal feucht

BEMERKUNGEN: BEHANDLUNG: INDIKATIONEN:

___________________________
ASEPSIA ___________________________
Ausreichend Unzureichend Sehr unzureichend Schuhwerk
PROMOTION ___________________________
_____________________________________________ RILLENREINIGUNG ___________________________
_____________________________________________ ONYCOTOMY ________________________
_____________________________________________ DISPARAGEMENT ________________________
_____________________________________________ RESECADO ________________________
_____________________________________________ HELOTOMIE ________________________
_________________________________________________
ROUGHING ________________________
___________________________________________ PULIDO ________________________
___________________________________________ ABSCHLIESSENDE ASEPSIS ________________________
___________________________________________ ________________________
___________________________________________ SONSTIGE: ________________________
____________________________________________________________________________ ________________________
____________________________________________________________________________ ________________________
____________________________________________________________________________
___________________________________________ _________________________________ DATE :____/____/________
___________________________________________ _________________________________
__________________________________________ _________________________________ HÄNDLER:
__________________________________________ _________________________________
__________________________________________ _________________________________
__________________________________________