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Type of Wound
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Attach photo of wound to chart
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location of wound
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If not able to complete assessment of wound why?
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Wound measurements
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Is there exudate
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Exudate amount and type
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Color and consistency of exudate
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Temperature of surrounding skin
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Wound edges appearance
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Condition of wound bed
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Signs of infection
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Any pain associated with wound
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Is analgesia required prior to dressing change
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Name of provider who initiated orders
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Cleansing Method
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Type of dressing
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Dressing frequency
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Name of HH doing dressings
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Any new wound care orders
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Any DME orders
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Any nutritional orders
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Positioning orders
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Plan of care
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Any referral orders
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Follow up visits
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Provider name
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