1. Type of wound: ex. Diabetic ulcer
Case Study Template
Type of wound: ex. Diabetic ulcer
Clinician Name:
Title:
Name of Affiliated Facility:
Consent form submitted:
Yes No

2. Past wound history and management Patient History: Age & sex
Past 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 description
Pain level and management

4. Name of wound: i.e. DFU- Left leg
Current wound history and management
Date of wound picture:
Wound measurement in cm :
Brief Description:
Wound characteristics: slough 10%, bone exposed
Pertinent information on wound status and patient’s condition if applicable
Pain 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 cast
Compression wrap
Wound picture
Name of wound: i.e. DFU- Left leg
Aside from picture of wound, please include pictures of Kerecis on wound, application techniques, etc

5. Name of wound: i.e. DFU- Left leg
Current wound history and management
Date of wound picture:
Wound measurement in cm :
Brief Description:
Wound characteristics: slough 10%, bone exposed
Pertinent information on wound status and patient’s condition if applicable
Pain 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 cast
Compression wrap
Wound picture
Name of wound: i.e. DFU- Left leg
Aside from picture of wound, please also take pictures of Kerecis on wound, application techniques, etc

6. Name of wound: i.e. DFU- Left leg
Current wound history and management
Date of wound picture:
Wound measurement in cm :
Brief Description:
Wound characteristics: slough 10%, bone exposed
Pertinent information on wound status and patient’s condition if applicable
Pain 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 cast
Compression wrap
Wound picture
Name of wound: i.e. DFU- Left leg
Aside from picture of wound, please also take pictures of Kerecis on wound, application techniques, etc

7. Name of wound: i.e. DFU- Left leg
Current wound history and management
Date of wound picture:
Wound measurement in cm :
Brief Description:
Wound characteristics: slough 10%, bone exposed
Pertinent information on wound status and patient’s condition if applicable
Pain 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 cast
Compression wrap
Wound picture
Name of wound: i.e. DFU- Left leg
Aside from picture of wound, please also take pictures of Kerecis on wound, application techniques, etc

8. Name of wound: i.e. DFU- Left leg
Current wound history and management
Date of wound picture:
Wound measurement in cm :
Brief Description:
Wound characteristics: slough 10%, bone exposed
Pertinent information on wound status and patient’s condition if applicable
Pain 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 cast
Compression wrap
Wound picture
Name of wound: i.e. DFU- Left leg
Aside from picture of wound, please also take pictures of Kerecis on wound, application techniques, etc

9. Name of wound: i.e. DFU- Left leg
Current wound history and management
Date of wound picture:
Wound measurement in cm :
Brief Description:
Wound characteristics: slough 10%, bone exposed
Pertinent information on wound status and patient’s condition if applicable
Pain 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 cast
Compression wrap
Wound picture
Name of wound: i.e. DFU- Left leg
Aside from picture of wound, please also take pictures of Kerecis on wound, application techniques, etc

10. Name of wound: i.e. DFU- Left leg
Current wound history and management
Date of wound picture:
Wound measurement in cm :
Brief Description:
Wound characteristics: slough 10%, bone exposed
Pertinent information on wound status and patient’s condition if applicable
Pain 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 cast
Compression wrap
Wound picture
Name of wound: i.e. DFU- Left leg
Aside from picture of wound, please also take pictures of Kerecis on wound, application techniques, etc