Get Yellow Flags Form - Upmc Health Plan

The Yellow Flags Form is a crucial tool for assessing the impact of pain and related symptoms on your daily life. This guide provides clear instructions on how to complete the form online, ensuring you provide accurate and helpful information.

Follow the steps to fill out the Yellow Flags Form effectively.

1. Press the ‘Get Form’ button to access the Yellow Flags Form and open it for editing.
2. Indicate your usual level of pain over the past week by selecting a number from 0 to 10, where 0 represents no pain and 10 represents the worst possible pain.
3. Assess if pain, numbness, tingling, or weakness extends into your leg or arm by choosing from the scale provided, from 0 (none of the time) to 10 (all of the time).
4. Rate your general health by selecting a number from 0 to 10, with 0 for poor health and 10 for excellent health.
5. Reflect on how you would feel spending the rest of your life with your current condition and choose a number from 0 (terrible) to 10 (delighted).
6. Evaluate how anxious you have felt in the past week by selecting a number from 0 (not at all anxious) to 10 (extremely anxious).
7. Indicate how well you have been able to manage your pain autonomously over the past week by choosing from 0 (not at all) to 10 (can reduce it significantly).
8. Rate your feelings of depression during the last week by selecting a number from 0 (not depressed at all) to 10 (extremely depressed).
9. Assess your certainty in being able to resume normal activities or work in six months, using the scale from 0 (not certain at all) to 10 (very certain).
10. Respond to questions about your ability to perform light work and sleep at night by indicating your level of agreement on a scale from 0 (completely disagree) to 10 (completely agree).
11. Consider whether an increase in pain signals a need to stop your activities; choose a number from 0 (completely disagree) to 10 (completely agree).
12. Indicate your belief about physical activity worsening your pain by selecting from 0 (completely disagree) to 10 (completely agree).
13. Finally, express your opinion on whether you should refrain from normal activities due to present pain, marking your agreement from 0 (completely disagree) to 10 (completely agree).
14. Print your name, provide your signature, and add the date at the bottom of the form to complete the submission.
15. After completing the form, you can save your changes, download, print, or share it as needed.

Complete your Yellow Flags Form online today to facilitate your health management.