
URN:Persistent Pain Management Service ePPOC Initial QuestionnaireFamily name: Given name(s): Date of Birth:Section 1 Your details TitleMr MsMrs MissGender MaleFemaleFamily name (surname)Given name(s)Date.
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How to fill out the Eppoc Questionnaire online
Filling out the Eppoc Questionnaire online is a crucial step for effective pain management. This comprehensive guide provides clear, step-by-step instructions to help you navigate through the form effortlessly.
Follow the steps to accurately complete the Eppoc Questionnaire.
- Click 'Get Form' button to obtain the Eppoc Questionnaire and open it in the editor.
- Fill in your details in Section 1. Provide your title, gender, family name, given name(s), date of birth, today's date, address, phone numbers, email, and country of birth. Ensure all information is accurate.
- Indicate if you require an interpreter and specify the language if applicable. Answer questions regarding any hearing or sight impairments and additional support you may need.
- Complete the medical history section by confirming if you are of Aboriginal or Torres Strait Islander origin and if you have served in the Australian Defence Force or are a client of the Department of Veterans’ Affairs.
- Respond to questions related to pain, its duration, and your experience with it. Choose the appropriate options based on how your pain began and how long you have experienced it.
- Provide information about any other medical conditions, as well as how often you have sought medical attention for your pain in the past three months.
- Fill out Section 2 about your employment status, missed hours, and how pain affected your productivity at work. Choose the options that best reflect your situation.
- In Section 3, list all medications you are currently taking, including their names and dosages, if applicable.
- Shade the areas of pain on the diagrams in Section 4 and rate your pain on the provided scale.
- Complete the DASS21 and PSEQ sections in subsequent parts of the questionnaire by rating your experiences and confidence related to pain.
- Once all sections are filled out, review your answers for accuracy before saving your changes, downloading, printing, or sharing the completed form.
Start filling out your Eppoc Questionnaire online today to take a step towards effective pain management.
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What is ePPOC?
ePPOC involves the collection of a standard set of information by specialist pain services. This information is used to guide treatment for individual patients, measure outcomes following treatment and provide a benchmarking system for the pain sector.
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