Post-Radiation Skin Injury Assessment Template
Patient Name
Assessment Date
Radiation Site
Fraction Number
Skin Appearance
Intact
Erythema
Dry Desquamation
Moist Desquamation
Ulceration
Necrosis
Affected Area (description or measurement)
Pain Level
None
Mild
Moderate
Severe
Pruritus (Itching)
None
Mild
Moderate
Severe
Edema (Swelling)
None
Mild
Moderate
Severe
Current Interventions / Treatments
Additional Notes