Home Wound Care Assessment Sheet
Date:
Patient Name:
Assessed By:
Wound Information
Wound Location:
Wound Type:
Wound Size (cm):
Wound Appearance:
Exudate:
None
Scant
Moderate
Heavy
Odor:
None
Foul
Sweet
Surrounding Skin:
Pain Assessment
Pain Level (0-10):
Pain Description:
Dressing
Dressing Type:
Frequency of Change:
Signs of Infection
Sign
Observed
Redness
Swelling
Increased warmth
Pus/Discharge
Fever
Other Notes