PAIN dIAgRAM On a scale of 1– to –10, how would describe your pain ...
PATIENT NAME: ________________________________________________________________________________________________
First
MI
Last
PAIN dIAgRAM
On a scale of 1? to ?10, how would describe your pain level when it is at its worse?
No Complaints
qq qq qq qqq q 01 23 45 678 9
Extreme Pain 10
Place an "X" on the area of pain; use the appropriate symbol of other symptoms you feel. If you are being seen for your foot or hand/wrist, use the diagrams at the bottom.
Pain
Aching
Numbness
Pins & Needles Burning
Stabbing
xxx
???
+++
???
///
Front View
Back View
Left
Right
_______________________________________________
Signature
_______________________________________________
Name of Person Completing this Form
Right
Left
________________________________________________
Date
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
- osteomalacia soft bones versus arthritis
- the diabetic neuropathies types diagnosis and management
- an introduction to pain pathways and 2
- diabetic neuropathies the nerve damage of diabetes veterans affairs
- pain current understanding of assessment management and treatments
- newport orthopedic institute pain diagram
- pain diagram on a scale of 1 to 10 how would describe your pain
- pain the basic facts national multiple sclerosis society
- somatosensory pathways
- chart of effects of spinal misalignments unity family chiropractic
Related searches
- how to describe your life
- how would you describe yourself
- how would i describe myself
- how to describe your lifestyle
- numbers 1 to 10 printable
- how would your coworkers describe you
- scale of 1 10 template
- 1 to 10 in hebrew
- list of 1 7 10 mods
- based on the model of primary leadership skills figure 5 1 how would you de
- 1 to 10 dilution calculator
- 1 to 10 tracing worksheet