Get Comprehensive Pain Assessment Form 2013-2025

Filling out the Comprehensive Pain Assessment Form online can be a straightforward process when you follow the appropriate steps. This guide aims to provide you with clear, detailed instructions to help you successfully complete the form and accurately represent your pain assessment.

Follow the steps to effectively complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your personal information at the top of the form, including your name and identification number. Ensure that these details are accurate.
3. Next, fill in the assessment date and time, along with the physician responsible for your care.
4. Indicate your pain control goal by selecting an appropriate number from the pain rating scale provided, from 0 (no pain) to 10 (worst possible pain).
5. In the section for current pain-related diagnoses, list any relevant medical conditions or diagnoses you have.
6. Select the type of pain you are experiencing by marking 'nociceptive', 'neuropathic', or 'mixed'.
7. Indicate whether you are experiencing depression by checking 'yes' or 'no'.
8. Fill out your individual pain intensity goal by checking the appropriate boxes related to your comfort preferences.
9. Provide a reason for the assessment, including specific conditions or occurrences that prompted your evaluation.
10. Complete the depression scale and any pertinent history of pain, including the onset and frequency of your pain.
11. Describe any changes in your pain pattern that you have noticed within the last seven days.
12. List potential causes or triggers for your pain, as well as what methods you have found to relieve your pain.
13. Document your medication history, including any current treatments or therapies.
14. Assess the impact of your pain over the past 24 hours in different areas of life, using the provided scale.
15. Indicate the worst pain you felt in the past 24 hours and how much relief you received from medications or treatments.
16. Outline a plan for addressing your pain, noting any referrals that may be necessary and commenting on your concerns or observations.
17. Finally, sign the form, indicating your title and the date of completion.
18. Once you have completed the form, ensure to save changes, download, print, or share the completed form as needed.

Complete your Comprehensive Pain Assessment Form online to effectively communicate your needs.