Wound Care Assessment Form

Wound Care Assessment Form — Form Fields

This healthcare template includes 9 fields. Comprehensive wound care assessment form for documenting wound characteristics, treatment history, and healing progress. Ideal for home health agencies, wound care clinics, and hospital units. Free to customize and use on ZenBuild.

• Patient Name (text, required)
• Date of Assessment (text, required)
• Wound Location (dropdown selection, required) — options: Lower Extremity, Upper Extremity, Trunk / Torso, Sacral / Coccyx, Head / Neck, Other
• Wound Type (dropdown selection, required) — options: Pressure Ulcer, Surgical Wound, Diabetic Ulcer, Venous Ulcer, Arterial Ulcer, Traumatic Wound, Burn
• Wound Dimensions (L x W x D in cm) (text, required)
• Wound Bed Tissue Type (multiple choice, required) — options: Granulation (red), Slough (yellow), Eschar (black), Epithelial (pink), Mixed
• Signs of Infection (select all that apply) (checkboxes, optional) — options: Increased redness / erythema, Warmth around wound, Purulent drainage, Foul odor, Fever, None observed
• Current Treatment / Dressing (long text, required)
• Wound Photo (optional) (file upload, optional)