Case Study Template Type of wound ex Diabetic
Case Study Template Type of wound: ex. Diabetic ulcer Clinician Name: Title: Name of Affiliated Facility: Consent form submitted: Yes No
Past wound history and management Patient History: Age & sex Past medical and surgical history: Pertinent history to wound: Age of wound: Prior to starting Kerecis Omega 3 Wound Previous treatment: Ex: hydrogel, collagen dressings, NPWT, other cellular tissue base products Wound characteristic: Initial wound description Pain level and management
Current wound history and management Date of wound picture: Wound measurement in cm : Brief Description: Wound characteristics: slough 10%, bone exposed Pertinent information on wound status and patient’s condition if applicable Pain level Wound progress: ex. Epithelialization, granulation For last slide, include clinical outcome Wound Treatment: ex: Kerecis Omega 3 Wound secured with steri-strips covered with contact layer, silver dressing secured with roll gauze. Total contact cast Compression wrap Wound picture Name of wound: i. e. DFU- Left leg Aside from picture of wound, please include pictures of Kerecis on wound, application techniques, etc
Current wound history and management Date of wound picture: Wound measurement in cm : Brief Description: Wound characteristics: slough 10%, bone exposed Pertinent information on wound status and patient’s condition if applicable Pain level Wound progress: ex. Epithelialization, granulation For last slide, include clinical outcome Wound Treatment: ex: Kerecis Omega 3 Wound secured with steri-strips covered with contact layer, silver dressing secured with roll gauze. Total contact cast Compression wrap Wound picture Name of wound: i. e. DFU- Left leg Aside from picture of wound, please also take pictures of Kerecis on wound, application techniques, etc
Current wound history and management Date of wound picture: Wound measurement in cm : Brief Description: Wound characteristics: slough 10%, bone exposed Pertinent information on wound status and patient’s condition if applicable Pain level Wound progress: ex. Epithelialization, granulation For last slide, include clinical outcome Wound Treatment: ex: Kerecis Omega 3 Wound secured with steri-strips covered with contact layer, silver dressing secured with roll gauze. Total contact cast Compression wrap Wound picture Name of wound: i. e. DFU- Left leg Aside from picture of wound, please also take pictures of Kerecis on wound, application techniques, etc
Current wound history and management Date of wound picture: Wound measurement in cm : Brief Description: Wound characteristics: slough 10%, bone exposed Pertinent information on wound status and patient’s condition if applicable Pain level Wound progress: ex. Epithelialization, granulation For last slide, include clinical outcome Wound Treatment: ex: Kerecis Omega 3 Wound secured with steri-strips covered with contact layer, silver dressing secured with roll gauze. Total contact cast Compression wrap Wound picture Name of wound: i. e. DFU- Left leg Aside from picture of wound, please also take pictures of Kerecis on wound, application techniques, etc
Current wound history and management Date of wound picture: Wound measurement in cm : Brief Description: Wound characteristics: slough 10%, bone exposed Pertinent information on wound status and patient’s condition if applicable Pain level Wound progress: ex. Epithelialization, granulation For last slide, include clinical outcome Wound Treatment: ex: Kerecis Omega 3 Wound secured with steri-strips covered with contact layer, silver dressing secured with roll gauze. Total contact cast Compression wrap Wound picture Name of wound: i. e. DFU- Left leg Aside from picture of wound, please also take pictures of Kerecis on wound, application techniques, etc
Current wound history and management Date of wound picture: Wound measurement in cm : Brief Description: Wound characteristics: slough 10%, bone exposed Pertinent information on wound status and patient’s condition if applicable Pain level Wound progress: ex. Epithelialization, granulation For last slide, include clinical outcome Wound Treatment: ex: Kerecis Omega 3 Wound secured with steri-strips covered with contact layer, silver dressing secured with roll gauze. Total contact cast Compression wrap Wound picture Name of wound: i. e. DFU- Left leg Aside from picture of wound, please also take pictures of Kerecis on wound, application techniques, etc
Current wound history and management Date of wound picture: Wound measurement in cm : Brief Description: Wound characteristics: slough 10%, bone exposed Pertinent information on wound status and patient’s condition if applicable Pain level Wound progress: ex. Epithelialization, granulation For last slide, include clinical outcome Wound Treatment: ex: Kerecis Omega 3 Wound secured with steri-strips covered with contact layer, silver dressing secured with roll gauze. Total contact cast Compression wrap Wound picture Name of wound: i. e. DFU- Left leg Aside from picture of wound, please also take pictures of Kerecis on wound, application techniques, etc
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