Home Wound Care Assessment
Patient Name
Assessment Date
Wound Location
Wound Type
Surgical
Pressure Ulcer
Diabetic Ulcer
Traumatic
Other
Length (cm)
Width (cm)
Depth (cm)
Wound Appearance
Exudate (Drainage)
None
Scant
Moderate
Heavy
Odor
None
Faint
Moderate
Strong
Pain Level (0-10)
Periwound Skin Condition
Care/Intervention Provided
Additional Notes