brevaLaceration repair note
Encounter
Patient name: [ ] Date of birth: [ ] Date and time of encounter: [ ] Clinician: [ ]
Wound evaluation
Time and mechanism of injury: [ ] Site, laterality, length and depth: [ ] Contamination, foreign body and associated injury assessment: [ ] Functional and neurovascular findings: [ ] Tetanus history assessed and action taken: [ ] Relevant history, medications and allergies: [ ]
Consent and procedure
Options, risks and alternatives discussed; consent obtained or declined: [ ] Site verification: [ ] Anesthetic agent, concentration, amount and route if used: [ ] Cleansing, irrigation and exploration performed: [ ] Closure method, material and number of sutures or staples if used: [ ] Dressing, complications and patient response: [ ]
Disposition
Post-procedure reassessment: [ ] Wound care and return precautions discussed: [ ] Follow-up and removal plan if applicable: [ ]