Site (include laterality):

• Elbow
• Back (upper/lower)
• Sacral
• Hip
• Buttock
• Ankle
• Heel
• Head
• Other (specify)

 

Pressure Ulcer Stage:

• Stage 1
• Stage 2
• Stage 3
• Stage 4
• Unspecified

With gangrene

• Document if ulcer (including stage) is present on admission