Diabetic Foot Ulcer Care Plan

Patient Information

Name Date of Birth Medical Record Number Diagnosis Date of Assessment

Ulcer Assessment

Location Size (L x W x D in cm) Stage/Grade Appearance Exudate Odor Signs of Infection Other Observations

Assessment Findings

Vascular Status	Neurologic Status	Other Complications

Goals

Interventions

Intervention	Frequency	Responsible

Evaluation

Recommendations / Follow-up