Transplant Graft Health Assessment Form
Please complete this assessment to help evaluate the current status and health of the transplant graft. All questions are designed for a structured, objective review.
Overall graft status
*
Stable
Improving
Unchanged
Worsening
Presence of graft-related symptoms
*
Pain or tenderness
Redness
Swelling
Warmth
Discharge
None of the above
Graft function assessment
*
Normal
Mildly impaired
Moderately impaired
Severely impaired
Signs of possible rejection
*
No signs
Suspected
Confirmed
Not assessed
Graft appearance (visual inspection)
*
Normal
Pale
Dusky
Cyanotic
Pain severity (0 = none, 10 = worst)
*
None
0
1
2
3
4
5
6
7
8
9
Worst
10
0 is None, 10 is Worst
Edema (swelling) level
*
None
Mild
Moderate
Severe
Temperature at graft site (°C)
*
Any recent interventions or changes in management?
*
No
Yes
Overall assessment rating
*
1
2
3
4
5
Submit Assessment
Should be Empty: