Wound Dressing Change Schedule Form
Use this form to document and track wound dressing changes, ensuring timely care and follow-up for each patient.
Patient Initials
*
Wound Location
*
Wound Type
*
Please Select
Surgical
Pressure Ulcer
Diabetic Ulcer
Venous Ulcer
Traumatic
Other
Date of Last Dressing Change
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Date of Next Scheduled Change
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Type of Dressing Used
*
Please Select
Gauze
Foam
Hydrocolloid
Alginate
Film
Other
Condition of Wound at Change
*
Please Select
Improved
Unchanged
Worsened
Complications or Issues Observed
*
Infection
Bleeding
Odor
Excess Drainage
None
Other
Name of Person Changing Dressing
*
Additional Notes / Follow-up Instructions
Submit Schedule
Should be Empty: