1. MY WOUND/PRESSURE ULCER PASSPORT
My Name is:
I like to be known as:
Date of Birth:
PRESSURE ULCER NUMBER
ANATOMICAL LOCATION
PU STAGE
I am allergic to:
For more information about me you can contact:
(next of kin, carer, parent, guardian)
Incident Report completed? YES/NO
Pressure Relieving Equipment in use? YES/NO
(If YES) equipment in use:
I have been informed by my nurse that I have a pressure ulcer: Yes/No
I am also known to the following Services:
LEG ULCER (DATE OF ONSET)
ANATOMICAL LOCATION
VENOUS/ARTERIAL/MIXED AETIOLOGY
District Nursing Team Tissue Viability Service
DN Team: DN Contact number:
Vascular Services Podiatry Service
  Dietician Continence Service
I am receiving care for my wound from:
OTHER WOUND. PLEASE STATE EG SURGICAL WOUND, DIABETIC FOOT ULCER
ANATOMICAL LOCATION
CURRENT TREATMENT (ALL WOUNDS)
Leg Ulcer Clinic District Nurse Treatment Room
Other Please state: ………………………………………..
My Last Doppler/ABPI assessment was on the : Results: ……………………………………………………………………..

2. To help all wounds heal it is important that you:
Eat well and drink plenty of fluids.
Be as active as you can be. If possible move around every 30 minutes to help with blood flow and relieve pressure to vulnerable areas.
Check your skin regularly or allow your carers or appropriate healthcare professionals to do this for you.
Tell your nurse or carer if you find any changes or feel any painful areas to your skin.
Use any equipment your nurse or therapist provides for you. If you are finding this a problem for any reason let your nurse or therapist know.
Discuss any problems or questions you have with your wound treatment with your nurse. If you are not happy with something there may be an alternative which can be tried.