Form: Wound Assesment

Age*
Weight
Gender
Nutrition status:
Mobility status:
Smoking:
Alcohol(units/week):
Co-morbidities:

Wound Type
Duration of wound:
Previous treatments:

Tissue type

Necrotic(%)
Sloughy(%)
Granulating (%)
Epithelialising (%)

Exudate

Level
Type

Infection

Status

Management goals

Management goals

Treatment choice

Treatment:
Dressing type/name:
Reason for choosing dressing:

Follow up plan

Date of next visit:
Main objective at next visit:
Save Cancel