Elementor #1720

Pressure Injury Documentation & Surveillance Form

For documentation, surveillance and nursing supervision purposes only.

Tip: Fill during rounds. Conditional fields appear automatically.

1) Patient Identification

Bed Number

Date of Admission

Braden Risk Category

High Moderate Low

Bed Sore / Pressure Injury Present

Yes No

Pressure Injury Developed

Outside Hospital (Present on Admission) Within Hospital

Select location(s) involved

For each selected location, choose stage.

Location	Stage

Documentation Completed in Nursing Notes

Yes No

Supervisor Name

Remarks (optional)

This demo stores nothing on a server. You can later connect it to Google Sheets / hospital HIS using IT support.