AYP Visit Doc.

AYP Mobile Wound Care Visit Form

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Date

MonthDayYear
Date
Hour MinutesAM/PM Option
Patient
Select a patient to view and record medical details, vital signs, and treatment images.

Jordan Physcian Order

Referral to Dr Piccolo Appt.: 3/31 @2 PM

Cleanse Lt foot wounds with DWC

Apply calcium alginate to wound bed

Cover with dry dressing and secure with wrap dressing

DO NOT soak feet

Non weight bearing to Lt foot

Referred To Dr Piccolo 3/31 @ 2PM

HH Pruit - Heidi
Jordan
POST-TREATMENT WOUND PHOTOS

REMEMEBER: RULER WITH PATIENT NAME AND DATE
- #1 Left plantar foot (1.0 cm-3 min)
- #1 Left plantar foot

Vandroff (M/W) Physcian

Cleanse Rt Lateral heel wound, Right mid footwound with DWC. Pack wound with moistened Dakin's solution. Cover with ABD pad and secure with tape.

ROHO cushion for wheelchair.

Low air loss surface to bed.
Time

Hour Minutes
Type a question
WOUND PHOTOS

REMEMEBER: RULER WITH PATIENT NAME AND DATE
- #1-Right lateral heel (6 cm - 3 min)
- #2-Right mid foot (0.9 cm - 3 min)
- #1-Right lateral heel
- #2-Right mid foot

Vandroff (T-TH)

Cleanse sacral wound, Right trochanter wound, Right ischial wound with DWC. Loosely pack all wound beds with calcium alginate. Cover with ABD pad and secure with tape.

ROHO cushion for wheelchair

Low air loss surface to bed
Vandroff
WOUND PHOTOS

REMEMEBER: RULER WITH PATIENT NAME AND DATE
- #1-Sacrum (48 cm - 7 min)
- #2-Right Trochanter (18 cm - 4 min)
- #3-Ishium (22 cm - 5 min)
- #1-Sacrum
- #2-Right Trochanter
- #3-Ishium

Brunson

Cleanse wounds with DWC. Apply foam adhesive dressing (allyvn). Change 3x week and soiling. non-contact ultramist 3x week
Brunson
WOUND PHOTOS

REMEMEBER: RULER WITH PATIENT NAME AND DATE
- #1-Rt Knee (1 cm - 3 min)
- #2-Lt Knee (3 cm - 3 min)
- #3-Right Trochanter (0.25 cm - 3 min)
- #1-Rt Knee (1 cm - 3 min)
- #2-Lt Knee (3 cm - 3 min)
- #3-Right Trochanter (0.25 cm - 3 min)

VITALS
BP (mmHg)
Temp (°F)
Resp.(breaths/min)
O2 (%)
HR (bpm)
Measurments

Wound Measurements

Rows	Legnth	Width	Depth
Wound #1
Wound #2
Wound #3
Wound #4
Wound #5
Wound #6
Wound #7

VISIT CLOSURE
Documented during today's visit
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