Printable Skin Assessment Form Details

A skin assessment form is a document that healthcare professionals use to record the condition of a patient's skin. This form can be used to track any changes in the skin, as well as identify any potential issues or concerns. By keeping track of a patient's skin health, professionals can provide better care and treatment. The form is also useful for patients, as they can use it to keep track of their own skin health and report any changes. There are many different types of skin assessment forms, so it is important to choose one that is specific to your needs.

Here, you will discover some specifics of skin assessment form PDF. There, you'll obtain the information regarding the PDF you intend to fill in, like the likely time required to complete it as well as other data.

QuestionAnswer
Form NameSkin Assessment Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesweekly skin assessment form, skin assessment blank printable sheets, skin assessment form printable, skin assessment form

Form Preview Example

Licensed Nurse Weekly Skin Assessment

RESIDENT: ______________________________________________________________ DATE:____________________ ROOM #:_________________

his form should be completed weekly on all residents per facility policy. Any areas of skin requiring treatment should have a thorough record of documentation in addition to this form located elsewhere in the chart per facility protocol. Check “Yes” or “No” if the item relects the resident’s assessment. If the answer is “yes” to 3 or more of the items listed below, consider implementation of the “Skin Tear Prevention Protocol.” Review the care plan to ensure skin care is included as necessary.

If any questions are answered “yes,” indicate location on body outline with number of question.

Weekly Skin Assessment

Any reddened areas that remain after 30 minutes of

1pressure reduction? COMMENTS: __________________

_____________________________________________

Yes No

o o

2

3

Any rashes? COMMENTS: ________________________

_____________________________________________

Any bruises? COMMENTS:________________________

_____________________________________________

Any open lesions, cuts, lacerations, or skin tears?

o o o o

4(Indicate even if being treated.) COMMENTS: ________

_____________________________________________

o o

5

Any blisters? COMMENTS:________________________

_____________________________________________

Any open ulcers (indicate even if being treated.)

o o

6COMMENTS: ___________________________________

_____________________________________________

o o

7

8

Excessively dry or laky skin? COMMENTS:___________

_____________________________________________

Any edema? LOCATION:__________________________

_____________________________________________

o o o o

Licensed Nurse Signature: _________________________________________________ Date: __________________

Document available at www.primaris.org

MO-08-09-PU MAY 2008 This material was prepared by Primaris, the Medicare Quality Improvement Organization for Missouri, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily relect CMS policy. Adapted from Ratlif Care Center.

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