Wound Management Initial Assessment
Patient Identifier :
190953VSEV
Hospital Identifier :
CHI
Name :
AITKEN, ALEXANDER
Date of Birth :
19/09/1953
Wound Details
Treatment Start Date:
/
/
Wound Number:
Estimated Duration of Ulcer:
Please Select
< 7 days
1 to 4 weeks
1 to 3 months
> 3 months
Causative Factors:
Please Select
Pressure
Ischaemia
Traumatic Penetration
Self Treatment
Unknown
Other
Location
Foot
Location 1
Location 2
Toe(s)
Please Select
Left
Right
Please Select
Dorsal
Plantar
Anterior Aspect
Posterior Aspect
Apex
Web Space
Subungal
Medial
Lateral
Please Select
Calcaneum
MPJ
IPJ
MLA
LLA
Malleolus
Toe(s)
Please Select
1
2
3
4
5
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