1. Dispensação de material para curativo domiciliar
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Assinatura da enfermeira responsável

2. Cadastro de paciente em curativo
Nome:______________________________________________________________________________________
Endereço: ____________________________________________________________________________________
Data de nascimento:______/______/_________ idade:_________ Telefone:___________________________
Doenças/ Hábitos
Hipertenso: ( ) sim ( )Não Cardíaco: ( ) sim ( )Não outros: ______________________
Diabético: ( ) sim ( )Não Vascular: ( ) sim ( )Não Fuma: ( ) sim ( )Não
Historia da ferida:______________________________________________________________
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Característica da ferida
Medicações em uso/pomadas Alergias medicamentosa/pomadas
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Localização Extensão
Tecido Exsudato Odor
Epitelização Sim Fétido
Granulação Pouco Característico
Macerada Médio Sem odor
Esfacelo Muito
Necrose Debridamento
Fibrina Não Cirúrgico
UBS Regional Sul