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=""]
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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