• Wound Infection Symptom Report Form

    Use this form to report symptoms that may indicate a wound infection. Please answer all questions accurately for effective assessment.
  • Date symptoms started*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Type of wound*
  • Redness around the wound*
  • Swelling around the wound*
  • Pain at the wound site*
  • Presence of pus or discharge*
  • Odor from the wound*
  • Fever (temperature above 100.4°F / 38°C)*
  • Do you have any of the following conditions?*
  • Should be Empty:
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