Date Wound filler type Therapy Therapy Wound margins Liner Exudate: Canister Therapy unit Indications Name and and amount cycle bordered? If Yes colour and changed charged and of Signature And Time used? Y/N. used setting type approx working Infection Y/N or n/a (Black/Green/ amount correctly? If Yes type Y** / N Y / N* White or Foam/Gauze)
Date And Time Wound filler type and amount used (Black/Green/ White Foam/Gauze) Therapy setting Therapy cycle or Wound margins bordered? If Yes type Liner used? Y/N. If Yes type Exudate: colour and approx amount Canister changed Y/N or n/a Therapy unit charged and working correctly? Y / N* Indications of Infection Y** / N Name and Signature