Wound Care Template new

On [date name="variable_22" default="06-15-2024"] MIC1 dispatched priority ___ to the above location for a scheduled appointment.

Wound Description

Location: 
[textarea name="variable_1" default=""]

Type of Wound:[comment memo=" pressure ulcer, surgical wound, diabetic ulcer, etc"]
[textarea name="variable_2" default=""]

Size:[comment memo="Length x Width x Depth, in cm"]
[textarea name="variable_3" default=""]

Shape:[comment memo="Describe shape, e.g., round, irregular"]
[textarea name="variable_4" default=""]

Wound Bed Appearance:
[comment memo="Describe color and tissue type, e.g., granulation tissue, slough, necrotic tissue"]
[textarea name="variable_5" default=""]

Exudate:

Amount:[comment memo="e.g., none, scant, moderate, heavy"]
[textarea name="variable_6" default=""]

Type:[comment memo="e.g., serous, sanguineous, purulent"]
[textarea name="variable_8" default=""]

Odor:[comment memo="e.g., none, mild, strong"]
[textarea name="variable_7" default=""]

Periwound Area

Condition of Surrounding Skin:
[comment memo="e.g., intact, erythematous, macerated, indurated"] 
[textarea name="variable_9" default=""]

Edema:
[comment memo="e.g., none, mild, moderate, severe"]
[textarea name="variable_10" default=""]

Pain Assessment:
[textarea name="variable_11" default=""]

Pain Description:
[comment memo="e.g., throbbing, sharp, dull, constant, intermittent"]
[textarea name="variable_12" default=""]

Wound Care Management

Cleaning:
[comment memo="Describe cleaning method and solution used"]
[textarea name="variable_13" default=""]

Debridement:
[comment memo="Type and method, if applicable"]
[textarea name="variable_14" default=""]

Dressing Applied:
[comment memo="Type of dressing and rationale"]
[textarea name="variable_15" default=""]

Additional Treatments:
[comment memo="e.g., topical antibiotics, wound VAC, compression therapy"]
[textarea name="variable_19" default=""]

Patient Education:
[comment memo="Instructions provided to patient or caregiver"]
[textarea name="variable_18" default=""]

Assessment and Plan:

Current Healing Stage:
[comment memo="e.g., inflammatory, proliferative, maturation"]
[textarea name="variable_16" default=""]

Progress:
[comment memo="e.g., improving, stable, deteriorating"]
[textarea name="variable_20" default="sample text"]

Next Steps:
[comment memo="Plan for follow-up, additional treatments, referrals"]
[textarea name="variable_17" default=""]
On MIC1 dispatched priority ___ to the above location for a scheduled appointment.

Wound Description

Location:


Type of Wound: pressure ulcer, surgical wound, diabetic ulcer, etc


Size:Length x Width x Depth, in cm


Shape:Describe shape, e.g., round, irregular


Wound Bed Appearance:
Describe color and tissue type, e.g., granulation tissue, slough, necrotic tissue


Exudate:

Amount:e.g., none, scant, moderate, heavy


Type:e.g., serous, sanguineous, purulent


Odor:e.g., none, mild, strong


Periwound Area

Condition of Surrounding Skin:
e.g., intact, erythematous, macerated, indurated


Edema:
e.g., none, mild, moderate, severe


Pain Assessment:


Pain Description:
e.g., throbbing, sharp, dull, constant, intermittent


Wound Care Management

Cleaning:
Describe cleaning method and solution used


Debridement:
Type and method, if applicable


Dressing Applied:
Type of dressing and rationale


Additional Treatments:
e.g., topical antibiotics, wound VAC, compression therapy


Patient Education:
Instructions provided to patient or caregiver


Assessment and Plan:

Current Healing Stage:
e.g., inflammatory, proliferative, maturation


Progress:
e.g., improving, stable, deteriorating


Next Steps:
Plan for follow-up, additional treatments, referrals

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.05, 39 form elements, 58 boilerplate words, 20 text areas, 1 dates, 18 comments, 21 total clicks
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