Wound Solutions:
Stuart Edward Riggins

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Debridement Treatment

Debridement Treatment

Patient Information

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Wound Assessment

Gender
Race
Language(s)
Social History | Living Circumstances
Social History | Tabacco History*
Social History | Tabacco Usage
Social History | Alcohol History*
Social History | Alcohol Usage
Social History | Drug History*
Social History | Drug Usage

Review of Systems

Constitutional | Reported
Constitutional | Denied
Head | Reported
Head | Denied
Eyes | Reported
Eyes | Denied
Respiratory | Reported
Respiratory | Denied
Cardiovascular | Reported
Cardiovascular | Denied
Gastrointestinal | Reported
Gastrointestinal | Denied
Musculoskeletal | Reported
Musculoskeletal | Denied
Psychiatric | Reported
Psychiatric | Denied
Skin | Reported
Skin | Denied
Neurological | Reported
Neurological | Denied
Endocrine | Reported
Endocrine | Denied
Hematologic/Lymph | Reported
Hematologic/Lymph | Denied
Allergic/Immunologic | Reported
Allergic/Immunologic | Denied

Vital Signs

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Extremity Pulses [Left/Right]
Extremity Pulses [Lower/Upper]
Extremity Pulses

Physical Exam

Skin & Wound Assessment

The following reports on the FIRST WOUND only, possible other wounds will be reported in a separated form.

Wound Base Percentage | Description*
Odor*
Drainage/Exudate | Quantity*
Drainage/Exudate | Type*
Peri-Wound Skin*
Wound Margins/Edges*
Undermining*
Tunneling*
Wound Type*
Wound Site Pain*
Wound Healing Phase*
Wound Classification*
Wound Classification | Wound Types*

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Diagnoses

Plan

Used Sharps Debridement*
Type Of Debridement*
Instrumentation Used*
Anesthetic Used*
Anesthetic Type*
Blood Loss*

Procedure Summary

Fill out the numbered bold parts in the fields below this paragraph.

The Debridement Protocol was explained, and Verbal Consent was received from the patient prior to performing the Procedure. [1] {Eschar / Slough} and peri-wound skin was cleaned with 4 x 4 gauze soaked with [2] {Betadine Solution}. A [3] {cc syringe} with [4] {Anesthetic} [5] {%} and [6] {Gauge needle} was utilized to inject [7] {mL} intra-dermally. A [8] {#__ ) [9] (Scalpel blade} was used to excise [10] {Slough / Eschar} until subcutaneous tissue was 100% exposed. The wound was successfully debrided down to the subcutaneous tissue, and 100% if the necrotic tissue was removed. At that time the wound was cleansed with Betadine Solution and dressed with Calcium Alginate with Silver, covered with ABD Pad and secured with Silicone Border Gauze Dressing and Paper Tape. The patient tolerated the Procedure well.

Field 1*
Field 9*
Field 10*

Procedure Coding

Care Plan

Patient Education

Patient Education

Follow-Up Treatment

Follow Up Appointment*

Provider's Signature

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Provider's Signature

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