Allied Health Suzanne Gordon DOB 09/27/1988
Allied Health Report
Date | Time | Allied Health Report | Report File | Provider | ||||||
Date | Time | Allied Health Report | Report File | Provider | ||||||
Wound Type/Etiology (if known)Pressure ☐ Venous ☐ Arterial ☐ Diabetic ☐ Surgical 2°Intent ☐ Skin Tear ☐ Other ☐ If Pressure Ulcer, chart stage: Stage 1_________ Stage 2_________ Stage3_________ Stage 4_________ Stage X(unstageable)_________ Stage SDTI (Suspected Deep Tissue Injury)_________ MARK LOCATION OF WOUND/ULCER WITH AN ARROW OR AN ”X” Legend: X or Blank Space = Not Applicable (as per agency) …