Title Name of Affiliated Facility Consen t form submitted Yes No Type of wound ex Diabetic ulcer Patient History Age amp sex Past medical and surgical history ID: 743591
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Slide1
Case Study Template
Clinician Name:Title:Name of Affiliated Facility:Consent form submitted:Yes No
Type of wound: ex. Diabetic ulcerSlide2
Patient History:
Age & sexPast medical and surgical history:Pertinent history to wound:Age of wound:Prior to starting Kerecis Omega3 Wound Previous treatment:Ex: hydrogel, collagen dressings, NPWT, other cellular tissue base products
Wound characteristic:Initial wound descriptionPain level and management
Past wound history and managementSlide3Slide4
Date of wound picture:
Wound measurement in cm : Brief Description: Wound characteristics: slough 10%, bone exposedPertinent information on wound status and patient’s condition if applicablePain level Wound progress: ex. Epithelialization, granulation For last slide, include clinical outcome
Wound Treatment:ex: Kerecis Omega3 Wound secured with steri-strips covered with contact layer, silver dressing secured with roll gauze. Total contact castCompression wrap
Wound picture
Name of wound: i.e. DFU- Left leg
Current wound history and management
Aside from picture of wound, please include pictures of
Kerecis
on wound, application techniques,
etcSlide5
Date of wound picture:
Wound measurement in cm : Brief Description: Wound characteristics: slough 10%, bone exposedPertinent information on wound status and patient’s condition if applicablePain level Wound progress: ex. Epithelialization, granulation For last slide, include clinical outcomeWound Treatment:
ex: Kerecis Omega3 Wound secured with steri-strips covered with contact layer, silver dressing secured with roll gauze. Total contact castCompression wrap
Wound picture
Name of wound: i.e. DFU- Left leg
Current wound history and management
Aside from picture of wound, please also take pictures of
Kerecis
on wound, application techniques,
etcSlide6
Date of wound picture:
Wound measurement in cm : Brief Description: Wound characteristics: slough 10%, bone exposedPertinent information on wound status and patient’s condition if applicablePain level Wound progress: ex. Epithelialization, granulation For last slide, include clinical outcomeWound Treatment:
ex: Kerecis Omega3 Wound secured with steri-strips covered with contact layer, silver dressing secured with roll gauze. Total contact castCompression wrap
Wound picture
Name of wound: i.e. DFU- Left leg
Current wound history and management
Aside from picture of wound, please also take pictures of
Kerecis
on wound, application techniques,
etcSlide7
Date of wound picture:
Wound measurement in cm : Brief Description: Wound characteristics: slough 10%, bone exposedPertinent information on wound status and patient’s condition if applicablePain level Wound progress: ex. Epithelialization, granulation For last slide, include clinical outcomeWound Treatment:
ex: Kerecis Omega3 Wound secured with steri-strips covered with contact layer, silver dressing secured with roll gauze. Total contact castCompression wrap
Wound picture
Name of wound: i.e. DFU- Left leg
Current wound history and management
Aside from picture of wound, please also take pictures of
Kerecis
on wound, application techniques,
etcSlide8
Date of wound picture:
Wound measurement in cm : Brief Description: Wound characteristics: slough 10%, bone exposedPertinent information on wound status and patient’s condition if applicablePain level Wound progress: ex. Epithelialization, granulation For last slide, include clinical outcomeWound Treatment:
ex: Kerecis Omega3 Wound secured with steri-strips covered with contact layer, silver dressing secured with roll gauze. Total contact castCompression wrap
Wound picture
Name of wound: i.e. DFU- Left leg
Current wound history and management
Aside from picture of wound, please also take pictures of
Kerecis
on wound, application techniques,
etcSlide9
Date of wound picture:
Wound measurement in cm : Brief Description: Wound characteristics: slough 10%, bone exposedPertinent information on wound status and patient’s condition if applicablePain level Wound progress: ex. Epithelialization, granulation For last slide, include clinical outcomeWound Treatment:
ex: Kerecis Omega3 Wound secured with steri-strips covered with contact layer, silver dressing secured with roll gauze. Total contact castCompression wrap
Wound picture
Name of wound: i.e. DFU- Left leg
Current wound history and management
Aside from picture of wound, please also take pictures of
Kerecis
on wound, application techniques,
etcSlide10
Date of wound picture:
Wound measurement in cm : Brief Description: Wound characteristics: slough 10%, bone exposedPertinent information on wound status and patient’s condition if applicablePain level Wound progress: ex. Epithelialization, granulation For last slide, include clinical outcomeWound Treatment:
ex: Kerecis Omega3 Wound secured with steri-strips covered with contact layer, silver dressing secured with roll gauze. Total contact castCompression wrap
Wound picture
Name of wound: i.e. DFU- Left leg
Current wound history and management
Aside from picture of wound, please also take pictures of
Kerecis
on wound, application techniques,
etcSlide11