Provider Mobile Phone
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Provider Email
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Medical Decision Making (MDM & Plan)
Plan Wound Dressings
Gauze (moist or dry)
Hydrocolloid
Hydrogel
Alginate
Foam
Transparent Film
Antimicrobial (e.g., Silver, Iodine)
Collagen
Bioactive (e.g., growth factors)
Composite
Charcoal
Silicone
Impregnated Gauze
Unknown
Plan Topical Treatments
Antibiotic ointments (e.g., Neosporin, mupirocin)
Antifungal creams
Silver sulfadiazine
Iodine-based ointments
Hydrogel wound gels
Enzymatic debriding agents (e.g., collagenase)
Growth factor gels (e.g., becaplermin)
Lidocaine or pain relief creams
Moisturizers / barrier creams
Honey-based products (e.g., Manuka honey)
Wound Cleaning & Debridement
Plan Cleaning
Normal saline rinse
Antiseptic solutions (e.g., chlorhexidine, Dakin’s)
Surgical debridement
Mechanical debridement
Autolytic debridement
Enzymatic debridement
Supportive Measures
Plan Supportive Measures
Limb elevation
Compression Therapy - Compression stockings
Compression Therapy - Multilayer wraps
Compression Therapy - Unna boots
Offloading Devices - Total contact cast
Offloading Devices - Removable cast walker
Offloading Devices - Offloading boots/shoes
Offloading Devices - Foam padding
Edema control
Smoking cessation counseling
Nutritional support
Diabetes/glycemic control
Pain management
Medication adjustment
Plan Coordination Management
MDM Advanced Therapy Needed (if they met SOC)
Yes
No
MDM SOC Ongoing
Yes
No
MDM Systemic Conditions
MDM Prior Interventions
MDM Contraindications
Active infection
Progressive necrosis
Charcot arthropathy
Vasculitis
Ischemia
Necrotic wound bed
Inadequate systemic disease control
Use of liquid/gel CTP (non-covered product)
MDM Contraindications Details
Explain what and why you selected the treatments?
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