Get The Primary Care Low Back Disability Questionnaire (pclbdq)

Filling out the Primary Care Low Back Disability Questionnaire (PCLBDQ) online is an important step in communicating your low back pain and its impact on your daily life to your healthcare provider. This guide will walk you through the process of completing the questionnaire effectively.

Follow the steps to fill out the PCLBDQ online.

1. Press the ‘Get Form’ button to obtain the questionnaire and open it in your online document editor.
2. Begin by entering the patient’s last name, first name, and patient ID in the designated fields to accurately identify the individual completing the form.
3. Next, provide the provider’s last name, first name, and phone number (with area code) to ensure that the healthcare professional can follow up as needed.
4. Input the patient’s date of birth in the format MM/DD/YYYY to confirm their identity and age.
5. Read the instructions carefully. This section is crucial as it describes how to respond to the following questions related to your low back pain.
6. Proceed to fill out Section 1, which focuses on pain intensity. Circle the option that most accurately describes your level of pain.
7. Continue to Section 2 to assess how pain affects personal care. Again, circle the choice that best describes your situation.
8. Move on to Section 3, which pertains to lifting capabilities. Indicate how pain influences your ability to lift by selecting the appropriate response.
9. In Section 4, address how pain impacts your ability to walk. Choose the statement that most closely aligns with your experiences.
10. Evaluate sitting comfort in Section 5, making sure to circle the response that reflects your ability to sit without discomfort.
11. Assess your standing capability in Section 6. Choose the option that best represents your experience with standing and pain.
12. In Section 7, focus on your sleeping patterns and how they are affected by pain. Select the appropriate option.
13. For Section 8, consider your social life and how it is impacted by pain. Circle the choice that describes your situation accurately.
14. Analyze your traveling experience in Section 9. Indicate the level of pain you experience while traveling.
15. Finally, in Section 10, assess how your pain is changing over time. Circle the statement that describes your pain’s progression.
16. After completing all sections, review your responses for accuracy and completeness.
17. Sign and date the questionnaire to confirm that the information provided is correct.
18. Upon final review, you can choose to save the file, download it, print it, or share it with your healthcare provider.

Take the next step in managing your health by completing the Primary Care Low Back Disability Questionnaire online today.