Wound Assessment Form (Complicating Clinical Factors) vs 10-10-12 docx - michigan 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the facility name, resident's name, and health care insurance details at the top of the form.
3. Fill in the date of birth and gender, followed by the physician's name and contact information.
4. Assess and record the Braden Score and any advanced risk factors that may complicate wound healing.
5. Document wound specifics including etiology, depth of tissue injury, and location. Use anatomical descriptions for clarity.
6. Measure the wound dimensions in centimeters and describe tissue type/color along with any undermining or tunneling present.
7. Evaluate exudate characteristics and odor after dressing removal, ensuring to note any signs of infection or critical colonization.
8. Complete sections on wound edges/periwound condition, pedal pulses, pain assessment, and overall healing status.
9. Finally, document treatment plans including debridement types, topical/systemic treatments, and referral recommendations as necessary.

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