Post-Surgical Wound Discharge Assessment Form
Complete this assessment to evaluate the patient's wound status prior to discharge.
Wound Location
*
Wound Appearance
*
Clean, dry, and intact
Redness present
Swelling present
Discoloration
Other (specify)
Wound Edges
*
Well-approximated
Slightly separated
Significantly gaping
Presence of Drainage
*
None
Serous
Sanguineous
Purulent
Amount of Drainage
*
None
Scant
Moderate
Heavy
Signs of Infection (select all that apply)
*
Increased redness
Warmth
Swelling
Pain/tenderness
Foul odor
None of the above
Pain Level at Wound Site
*
No pain
0
1
2
3
4
5
6
7
8
9
Worst pain
10
0 is No pain, 10 is Worst pain
Condition of Dressing
*
Clean and dry
Slightly soiled
Saturated
Not applicable
Patient/Family Educated on Wound Care
*
Yes
No
Not applicable
Additional Comments or Observations
Submit Assessment
Should be Empty: