|
Nutrition
|
|
|
Patient is well nourished
|
Nourishment Comments
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|
Body Habitus
|
Body Habitus Comment
|
|
BMI Reference Chart
|
|
|
General/Neuro
|
|
|
General WNL
|
General Abnormal
• • •
|
|
General Comments
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|
|
Level of Consciousness
• • •
|
Level of Consciousness Comment
|
|
Mental Illness
|
Mental Illness Comment
|
|
Coordination
• • •
|
Coordination Comment
|
|
Grip Strength
|
Grip Strength Comment
|
|
MSK
|
|
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Upper Extremity
|
|
|
RUE Strength
|
LUE Strength
|
|
Lower Extremity
|
|
|
RLE Strength
|
LLE Strength
|
|
Abdomen
|
|
|
Abdominal Wound
|
|
|
Abdominal Exam
• • •
|
Abdominal Exam Comment
|
|
Vascular
|
|
|
Vascular Wound
|
|
|
CEAP Classification of Venous Disease
|
|
|
RUE
|
|
|
Pulse Location
|
Pulse Strength
|
|
Capillary Refill
|
|
|
Skin Assessment
• • •
|
|
|
Skin Temperature
|
|
|
Edema
|
|
|
RUE Comment
|
|
|
LUE
|
|
|
Pulse Location
|
Pulse Strength
|
|
Capillary Refill
|
|
|
Skin Assessment
• • •
|
|
|
Skin Temperature
|
|
|
Edema
|
|
|
LUE Comment
|
|
|
RLE
|
|
|
Pulse Location
|
Pulse Strength
|
|
Capillary Refill
|
|
|
Vascular Skin Changes
• • •
|
|
|
Skin Temperature
|
|
|
Skin Color
|
|
|
Edema
|
|
|
Digital Hair Growth
|
|
|
ABI
|
|
|
Vascular Changes Comment
|
|
|
LLE
|
|
|
Pulse Location
|
Pulse Strength
|
|
Capillary Refill
|
|
|
Vascular Skin Changes
• • •
|
|
|
Skin Temperature
|
|
|
Skin Color
|
|
|
Edema
|
|
|
Digital Hair Growth
|
|
|
ABI
|
|
|
Vascular Changes Comment
|
|
