REVIVA — Wound Assessment

📸 Photo

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📏 Measurements

Length (cm)

Width (cm)

Depth (cm)

Area (cm²)

Volume (cc)

🩸 Wound Bed Tissue Composition

Percentages should add up to 100%

Granulation (%)

Slough (%)

Eschar (%)

Epithelial (%)

Necrotic (%)

Total: 0%

🔍 Undermining & Tunneling

Undermining Location

Undermining Depth (cm)

Tunneling Location

Tunneling Depth (cm)

💧 Exudate

Amount

Type

Odor

🔄 Wound Edges & Periwound

Edge Type

Periwound Condition

😣 Pain Assessment

Pain Level (0-10)

Pain Type

Pain Timing

🦠 Infection Assessment

Signs of Infection Worsening pain Erythema (redness) Edema (swelling) Warmth Purulent exudate Odor Delayed healing Friable granulation

Antibiotics?

Culture Taken?

🏷️ Staging / Classification

NPUAP Pressure Injury Stage

Wagner Grade (Diabetic)

PUSH Score (0-17)

💊 Treatment

Dressing Type

Debridement performed Wound VAC / NPWT Compression therapy Offloading

Clinician Name

Patients

New Patient

Wounds

New Wound

Wound Assessment

Assessment History