Wound Procedure
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Pre-debridement Size
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Post-Debridement Size
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Graft Waste
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Graft Waste Comment
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Graft Size
• • •
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Graft Size Comment
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Graft Brand
• • •
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Graft Brand Comment
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Graft Lot Information
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Treatment Plan
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Diabetes Assessment & Plan:
• • •
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Tobacco Usage:
• • •
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Smoking Cessation:
• • •
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Additional Wounds
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