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Comorbidities
• • •
|
|
|
Dimensions
|
|
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# of ulcer
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Location
|
|
L__________
|
W______
|
|
D_______
|
Grade
|
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Type of Ulcer
• • •
|
|
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Characteristics
• • •
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Involvement
• • •
|
|
Drainage / Exudate
• • •
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Odor
• • •
|
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Granulation Tissue
• • •
|
uncovered
• • •
|
|
Edges Skin
• • •
|
|
|
Debridement
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|
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If yes, please select.
• • •
|
Please select
• • •
|
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Improvement
|
General Condition of Leg
• • •
|
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Treatment
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|
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Antibiotics
• • •
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ABx
|
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Culture
• • •
|
Labs
• • •
|
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X - ray
|
Bone Scan / MRI
|
|
Wound Healing Techniques
• • •
|
Doctor's remarks
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|
Assessment
• • •
|
Plan
• • •
|
|
Assessment
|
Plan
|
