3M™ Tegaderm™ Absorbent Clear Acrylic Dressing Evaluation
Name of Evaluator
Title
Phone Number
Date
Health Care Facility Name
Department
Sales Representative
Phone Number
Do you presently use a hydrocolloid dressing?
 Yes
 No
If yes, which brand_________________________
If no, what absorbent dressing do you use?
Brand__________________ Shapes/Sizes_______________
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Which Tegadern™ Absorbent Clear Acrylic Dressing did you try?
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 90800 oval 3 x 3.75 in
 90801 oval 4.4 x 5.0 in
 90802 square 5.9 x 6.0 in
 90803 oval 5.6 x 6.25 in
 90805 square 7.9 x 8.0 in
 90807 sacral 4.7 x 5.7
Please check the body location where Tegaderm™ Absorbent Clear Acrylic Dressing was applied:
 Coccyx/Sacrum
 Shoulder
 Elbow
 Arm
 Hip
 Heel
 Buttock
 Other______________________
Please check the type of use:
 Skin Tear
 Cover dressing with wound filler
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 Stage II pressure ulcer  Stage III pressure ulcer
Was a skin barrier used?
 Yes
 No
 Donor Site
 Other ________________
Brand_________________
Please rate Tegaderm™ Absorbent Clear Acrylic Dressing as it compares to dressing you use most often:
Much Better
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Overall performance
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Fluid handling capacity
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Length of Wear
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Nonadherency to wound bed
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Bunching
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Conformability
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Condition of periwound skin
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Adhesive residue on skin
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Patient comfort
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Ease of application
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Ease of removal
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Ability to monitor wound
Better
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Same
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Much Worse
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Additional
Comments
Skin & Wound Care Division
3M Health Care
3M Center, Building 275-4W-02
St. Paul, MN 55144-1000
USA
1-800-228-3957
www.3M.com/healthcare
3M Canada
P.O. Box 5757
London, Ontario N6A 4T1
Canada
1-800-364-3577
www.3M.com/ca/healthcare
Please recycle.
Printed in U.S.A.
© 3M 2002. Portions Copyright 2006, 2010.
All rights reserved.
3M and Tegaderm are trademarks of 3M.
Used under license in Canada.
70-2009-6373-7
N/A
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