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Patient Information
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Wound Classification
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Etiology
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Stage/Severity
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Position
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Anatomical Location
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Date Wound Acquired
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Wound Status
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Measurements and Description of Wound Bed
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Length
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Width
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Calculate Area
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Depth
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Undermining or Tunneling Present
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Undermining or Tunneling Description
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Granulation
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Eschar
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Slough
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Epithelialization
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Wound Edges
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Periwound
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Exudate Amount
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Exudate Description
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Odor Post-Cleansing
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Pain Evaluation
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Treatment Plan and Recommendations
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Dressing Change Frequency
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Cleanse Wound With
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Primary Wound Dressing (Wound Bed)
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Secondary Dressing
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Offloading Techniques
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Additional Recommendations
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Advanced Treatment Plans
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