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Vascular Assessment Form Cheat Sheet by

assessment     form     medical     vacscular

Presen­tating Proble­m/C­omp­laint

Descri­ption:
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Diagnoses Conditions

Cond­ition
Y/N
------­---­---­---­---­---­---­---­---­---­------- Deta­ils ------­---­---­---­---­---­---­---­---­---­-------
Diabetes Mellitis
[__]
Hypert­ension
[__]
Hyperl­ipi­daemia
[__]
CVA
[__]
Heart Disease
[__]
Syncope
[__]
Vascular Surgery Hx
[__]
Family Health
[__]

Risk Factors

Risk Factor
Amou­nt/­Fre­que­ncy­/Length of Time
Smoking
Alcohol
Lifestyle
Obesity

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