Get Pain Management Follow Up Form

Completing the Pain Management Follow Up Form online is an essential step in effectively managing your pain. This guide provides clear and detailed instructions to help you navigate each section of the form with ease.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your name and the date in the designated fields at the top of the form.
3. Provide the name of your referring physician to ensure proper communication regarding your care.
4. In section 1, circle the areas on the pain diagram to indicate where you feel pain. This visual representation is crucial for your healthcare provider.
5. Indicate any numbness or tingling by marking an 'x' on the diagram in the corresponding area.
6. Utilize the provided pain scale (0-10) to describe your pain levels at their worst, least, and as it currently is. Fill in these fields accurately.
7. Answer the questions regarding the origin of your pain, including the date of any injury, what triggered your pain, and whether you experience weakness, muscle spasms, or cramps.
8. Complete the sections covering your pain history, including how long you have been experiencing pain, its duration, and when your most recent episode of pain started.
9. Describe your pain characteristics by selecting all that apply from the given options (e.g., aching, throbbing).
10. Identify factors that alleviate or exacerbate your pain, marking all applicable choices.
11. Share any past treatments attempted for pain relief, as well as previous diagnostic imaging conducted for the painful area.
12. List your medical conditions and medications, including any known drug allergies and reactions.
13. Complete personal questions about your family medical history, relationship status, occupation, work status, and lifestyle habits.
14. Indicate any additional symptoms you experience, followed by information about your height and weight.
15. Finally, identify your dominant hand to assist with any necessary assessments.
16. After completing the form, review your entries for accuracy. You may then save changes, download, print, or share the form as needed.

Start filling out your Pain Management Follow Up Form online today to facilitate your path toward recovery.