Diabetic Foot Ulcer A/P

[text default="LEFT|RIGHT|BILATERAL Diabetic Foot Ulcer"
[select name="Q1" value="Wagner Grade 1 - Superficial|Wagner Grade 2 - Involves ligament/tendon/joint capsule/fascia WITHOUT Abscess/Osteomyelitis|Wagner Grade 3 - Deep Ulcer WITH Abscess/Osteomyelitis|Wagner Grade 4 - Gangrene to portion of midfoot|Wagner Grade 5 - Extensive gangrene"]
[textarea default="ANTIBIOTICS"]
[textarea default="EVALUATION:  ESR/CRP, CBC, X-ray, MRI"]
[textarea default="OTHER MEASURES:  Keep ulcer/foot above level of heart, Mechanical off loading of ulcer, Avoid barefoot walking, Wear proper fitting shoes, General foot care (clipped toenails, clean), Tobacco cessation counseling"]