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Run: Wound Treatment Administration Record

A wound treatment administration record for documenting ordered wound care, wound status, supplies used, and clinical sign-off in one place. Use it to keep d...

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Record Details

Record Date (required)

Shift (required)

Completed By (required)

Name and credentials of the staff member completing the record.

Completion Time (required)

Resident and Wound Identification

Resident Name (required)

Use the resident's full name as listed in the chart.

Medical Record Number

Optional if your facility uses another unique identifier for chart matching.

Wound Location (required)

Wound Type (required)

Laterality

Ordered Treatment

Treatment Order (required)

Enter the current wound care order exactly as prescribed, using minimum necessary detail.

Treatment Performed (required)

Reason for Deviation

Provider Notified

Yes No N/A

Wound Assessment

Wound Status (required)

Drainage Amount

Drainage Type

Odor Present

Peri-wound Condition

Dressing and Supplies

Dressing Changed (required)

Dressing Type Applied

Supplies Used

List only supplies used for the treatment, such as cleanser, gauze, packing material, or barrier cream.

Wound Measurement Updated Today

Yes No N/A

Pain, Tolerance, and Sign-Off

Pain Score During Treatment

Treatment Tolerance (required)

Patient Response / Notes

Document relevant observations, education provided, or follow-up needs.

Staff Signature (required)

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Email (required)

Your name (optional)

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