Get Esas

The Edmonton Symptom Assessment System revised (ESAS-r) is a tool that allows users to assess their symptoms while receiving care. This guide will provide you with step-by-step instructions on how to complete the ESAS form online effectively.

Follow the steps to complete the ESAS form online.

1. Click the ‘Get Form’ button to access the ESAS form and open it in your preferred online editor.
2. Begin by filling out your name in the designated Patient Name field to identify who is completing the assessment.
3. Next, enter the date using the format yyyy-Mon-dd, which will record when the assessment is being completed.
4. Record the time in the hh:mm format to indicate when you completed the form.
5. For each symptom listed, circle the number that best reflects your current experience, ranging from 0—indicating 'No' symptoms, to 10—indicating 'Worst Possible' symptoms. This includes pain, tiredness, drowsiness, nausea, lack of appetite, shortness of breath, depression, anxiety, and overall wellbeing.
6. If you are experiencing any other problems, such as constipation, indicate this by circling a number for the 'Other Problem' section and specifying what the issue is in the provided space.
7. Select who is completing the form by checking the appropriate box for either: Patient, Family Caregiver, Health Care Professional Caregiver, or Caregiver-assisted.
8. If applicable, use the Body Diagram on the reverse side to mark the areas where you experience pain, providing visual context to your reported symptoms.
9. Once all sections are completed, review your entries for accuracy. You will then have the option to save the changes, download, print, or share the completed form.

Complete your ESAS form online today to better monitor your symptoms and communicate with your care providers.