select count(1) as Wcount from #Request.prefix_db_agency#.PatientVisitDetails where PatientVisitDetails.Patient_ID='#session.cs.patientid#' and PatientVisitDetails.Wnd_Location<>'' and PatientVisitDetails.Wnd_Type<>'' and trim(Type)='Wound' and PatientVisitDetails.Assessment_ID='#Session.CS.AssessmentID#' SELECT Patient_ID, Last_Name_M0040 AS Last_Name, First_Name_M0040 AS First_Name, Middle_Initial_M0040 AS Middle ,Payer_ID FROM #Request.prefix_db_agency#.patient WHERE Patient_Id = '#session.cs.patientid#' AND Agency_Id = '#session.AgencyId#' SELECT * FROM #Request.prefix_db_agency#.Assessment_New WHERE Assessment_New.Assessment_ID='#session.cs.AssessmentId#' select Last_Name,First_Name from #Request.prefix_db_lookup#.Employee where Employee_ID = '#disform.Record_Created_By#' pat = CreateObject("Component", "patientadmin_new.patient.assessment"); get_pain_que = pat.get_pain_ques('9 - Discharge from agency','pain'); get_braden_que = pat.get_pain_ques('9 - Discharge from agency','braden'); get_fallrisk = pat.get_pain_ques('9 - Discharge from agency','fall_risk'); //get_score = pat.get_live_score();

#GetP.First_Name# #GetP.Last_Name#, Discharge From Agency

--->

Add vital

Type

Temperature Heart Rate Respiratory Rate Blood Pressure Systolic Blood Pressure Diastolic Weight Height Pain (scale 1-10) Abdominal Girth Head Circumference O2 Saturation

Severity

0 asymptomatic 1 well-controlled 2 controlled with difficulty 3 poorly controlled 4 hx hospitalizations

Reading

Notes

Vital

Add Vital

Pain Assessment

Pain Level

checked /> pain level 0 (low) checked /> pain level 1 (low) checked /> pain level 2 (low) checked /> pain level 3 (med) checked /> pain level 4 (med) checked /> pain level 5 (med)

checked /> pain level 6 (med) checked /> pain level 7 (high) checked /> pain level 8 (high) checked /> pain level 9 (high) checked /> pain level 10 (high)


0	2	4	6	8	10

pain assessment indicates #disform.M0420_Assess# #disform.Pain2# requiring medication every as needed pain relief resolves pain

Pain assessment incomplete

Pain Characteristics

checked /> Throbbing checked /> Stabbing checked /> Sharp checked /> Aching checked /> Burning

checked /> Numb checked /> Shooting checked/> Not Applicable checked/> Other

Pain threshold

checked/> at rest checked/> with minimal activity checked/> with moderate activity checked/> with strenuous activity checked/> Not Applicable

Whats is patient's opinion of the cause of her/his pain?

checked/> physical activity checked/> disease process checked/> Not Applicable checked/> Other...

Rate Current pain treatment effectiveness on a scale* of 1 to 10(1=low effectiveness)

checked/> 1 checked/> 2 checked/> 3 checked/> 4 checked/> 5

checked/> 6 checked/> 7 checked/> 8 checked/> 9 checked/> 10

How long does each treatment work before needing another dose

checked/> 30 minutes checked/> 1 hour checked/> 2 hours checked/> 3 hours checked/> 4 hours checked/> 6 hours

checked/> 12 hours checked/> 24 hours checked/> more than 24 hours checked/> Not Applicable checked/> Other

Braden Scale For Predicting Pressure Sore Risk

SENSORY PERCEPTION ability to respond meaningfully to pressure-related discomfort

checked onClick="PressureUlcersRisk();" name="drlPresureUlcersSensory" value="1. Unresponsive (does not moan, flinch, or grasp) to painful stimuli, due to diminished level of con-sciousness or sedation OR limited ability to feel pain over most of body"> 1. Unresponsive (does not moan, flinch, or grasp) to painful stimuli, due to diminished level of con-sciousness or sedation OR limited ability to feel pain over most of body checked onClick="PressureUlcersRisk();" name="drlPresureUlcersSensory" value="2. Responds only to painful stimuli. Cannot communicate discomfort except by moaning or restlessness OR has a sensory impairment which limits the ability to feel pain or discomfort over 2 of body."> 2. Responds only to painful stimuli. Cannot communicate discomfort except by moaning or restlessness OR has a sensory impairment which limits the ability to feel pain or discomfort over 2 of body. checked name="drlPresureUlcersSensory" value="3. Responds to verbal commands, but cannot always communicate discomfort or the need to be turned OR has some sensory impairment which limits ability to feel pain or discomfort in 1 or 2 extremities. "> 3. Responds to verbal commands, but cannot always communicate discomfort or the need to be turned OR has some sensory impairment which limits ability to feel pain or discomfort in 1 or 2 extremities. checked onClick="PressureUlcersRisk();" name="drlPresureUlcersSensory" value="4. Responds to verbal commands. Has no sensory deficit which would limit ability to feel or voice pain or discomfort."> 4. Responds to verbal commands. Has no sensory deficit which would limit ability to feel or voice pain or discomfort.

MOISTURE degree to which skin is exposed to moisture

checked name="drlPresureUlcersMoisture" value="1. Skin is kept moist almost constantly by perspiration, urine, etc. Dampness is detected every time patient is moved or turned."> 1. Skin is kept moist almost constantly by perspiration, urine, etc. Dampness is detected every time patient is moved or turned. checked name="drlPresureUlcersMoisture" value="2. Skin is often, but not always moist. Linen must be changed at least once a shift."> 2. Skin is often, but not always moist. Linen must be changed at least once a shift. checked onClick="PressureUlcersRisk();" name="drlPresureUlcersMoisture" value="3. Skin is occasionally moist, requiring an extra linen change approximately once a day."> 3. Skin is occasionally moist, requiring an extra linen change approximately once a day. checked onClick="PressureUlcersRisk();" name="drlPresureUlcersMoisture" value="4. Skin is usually dry, linen only requires changing at routine intervals."> 4. Skin is usually dry, linen only requires changing at routine intervals.

ACTIVITY degree of physical activity

checked name="drlPresureUlcersActivity" value="1. Confined to bed."> 1. Confined to bed. checked name="drlPresureUlcersActivity" value="2. Ability to walk severely limited or non-existent. Cannot bear own weight and/or must be assisted into chair or wheelchair. "> 2. Ability to walk severely limited or non-existent. Cannot bear own weight and/or must be assisted into chair or wheelchair. checked name="drlPresureUlcersActivity" value="3. Walks occasionally during day, but for very short distances, with or without assistance. Spends majority of each shift in bed or chair "> 3. Walks occasionally during day, but for very short distances, with or without assistance. Spends majority of each shift in bed or chair checked onClick="PressureUlcersRisk();" name="drlPresureUlcersActivity" value="4. Walks outside room at least twice a day and inside room at least once every two hours during waking hours "> 4. Walks outside room at least twice a day and inside room at least once every two hours during waking hours

MOBILITY ability to change and control body position

checked onClick="PressureUlcersRisk();" name="drlPresureUlcersMobility" value="1. Does not make even slight changes in body or extremity position without assistance "> 1. Does not make even slight changes in body or extremity position without assistance checked value="2. Makes occasional slight changes in body or extremity position but unable to make frequent or significant changes independently. "> 2. Makes occasional slight changes in body or extremity position but unable to make frequent or significant changes independently. checked onClick="PressureUlcersRisk();" name="drlPresureUlcersMobility" value="3. Makes frequent though slight changes in body or extremity position independently. "> 3. Makes frequent though slight changes in body or extremity position independently. checked onClick="PressureUlcersRisk();" name="drlPresureUlcersMobility" value="4. Makes major and frequent changes in position without assistance."> 4. Makes major and frequent changes in position without assistance.

NUTRITION usual food intake pattern

checked onClick="PressureUlcersRisk();" name="drlPresureUlcersNutrition" value="1. Never eats a complete meal. Rarely eats more than a of any food offered. Eats 2 servings or less of protein (meat or dairy products) per day. Takes fluids poorly. Does not take a liquid dietary supplement OR is NPO."> 1. Never eats a complete meal. Rarely eats more than a of any food offered. Eats 2 servings or less of protein (meat or dairy products) per day. Takes fluids poorly. Does not take a liquid dietary supplement OR is NPO. checked value="2. Rarely eats a complete meal and generally eats only about 2 of any food offered. Protein intake includes only 3 servings of meat or dairy products per day. Occasionally will take a dietary supplement."> 2. Rarely eats a complete meal and generally eats only about 2 of any food offered. Protein intake includes only 3 servings of meat or dairy products per day. Occasionally will take a dietary supplement. checked name="drlPresureUlcersNutrition" value="3. Eats over half of most meals. Eats a total of 4 servings of protein (meat, dairy products per day. Occasionally will refuse a meal, but will usually take a supplement when offered OR is on a tube feeding or TPN."> 3. Eats over half of most meals. Eats a total of 4 servings of protein (meat, dairy products) per day. Occasionally will refuse a meal, but will usually take a supplement when offered OR is on a tube feeding or TPN. checkedname="drlPresureUlcersNutrition" value="4. Eats most of every meal. Never refuses a meal. Usually eats a total of 4 or more servings of meat and dairy products. Occasionally eats between meals."> 4. Eats most of every meal. Never refuses a meal. Usually eats a total of 4 or more servings of meat and dairy products. Occasionally eats between meals.

FRICTION & SHEAR

checked value="1. Requires moderate to maximum assistance in moving. Complete lifting without sliding against sheets is impossible. Frequently slides down in bed or chair, requiring frequent repositioning with maximum assistance."> 1. Requires moderate to maximum assistance in moving. Complete lifting without sliding against sheets is impossible. Frequently slides down in bed or chair, requiring frequent repositioning with maximum assistance. checked value="2. Problem Moves feebly or requires minimum assistance. During a move skin probably slides to some extent against sheets, chair, restraints or other devices. Maintains relatively good position in chair or bed most of the time."> 2. Problem Moves feebly or requires minimum assistance. During a move skin probably slides to some extent against sheets, chair, restraints or other devices. Maintains relatively good position in chair or bed most of the time. checked> 3. Moves in bed and in chair independently and has sufficient muscle strength to lift up completely during move. Maintains good position in bed or chair.

1 - 12 =HIGH RISK

13 - 14 =MODERATE RISK

15 - 23 =LOW RISK

WoundAdd New Wound

Add

Wound Type

Abrasion Bite Burn Contusion Diabetic Ulcer Graft Gunshot Laceration Nodule

Pressure Ulcer Puncture Skin Tear Stab Stasis Ulcer Surgical Woundv Welt Other

If pressure ulcer stage

Status

Length

Width

Depth

Surrounding Tissues

clean scabbed crusted indurated gaping blistered separated bruised

Characteriscts

clean crusted gaping separated scabbed indurated blistered bruised cynanotic eschar excoriated Flaking hard necrotic reddened rough weeping sloughing green

dry cracked muschy soft loose --SHAPE-- straight circular irregular oblong rectangle square drainage no drainage block brown clear gray moist

pink red reddish purple serosanguineos serous tan yellow white haemoserous --AMOUNT-- scant minimal moderate copious --ODOR-- foul odor no odor Other..

Location

Notes