Get the free PAIN SELF-MANAGEMENT PROGRAM REFERRAL - cdha nshealth

PAIN SELF-MANAGEMENT PROGRAM REFERRAL PUMP Brochure Provided to Patient/Client Program Location of Interest: Halifax Dartmouth Name: Unit #: DOB: (Y/M/D) Health Card #: Address: Phone: (H) ((C) ()

How to fill out pain self-management program referral

How to fill out a pain self-management program referral:

1. Obtain the referral form: Contact the healthcare provider or clinic that oversees the pain self-management program to request the referral form. This may be available in a physical or electronic format.
2. Provide patient information: Fill in the necessary details about the patient for whom the referral is being made. This typically includes their full name, date of birth, contact information, and any relevant medical identification numbers.
3. Include healthcare provider details: Fill in the information of the healthcare provider who is referring the patient to the pain self-management program. This includes their name, credentials, contact information, and their relationship to the patient.
4. Indicate the reason for referral: Clearly state the reason for referring the patient to the pain self-management program. This could involve documenting the patient's chronic pain condition, the specific concerns or challenges they are facing, and the desired outcome or goals for participating in the program.
5. Provide supporting documentation: Attach any necessary supporting documentation that may be required with the referral. This could include medical records, test results, or any other relevant information that will help the pain self-management program understand the patient's medical history and current condition.
6. Obtain patient consent: Ensure that the patient is aware and consents to being referred to the pain self-management program. This involves explaining the purpose of the program, potential benefits, and their responsibilities as a participant. Obtain the patient's signature or verbal confirmation of consent, if required.

Who needs pain self-management program referral?

1. Patients with chronic pain: Individuals who experience chronic pain, which is defined as pain that lasts for more than three to six months, may benefit from a pain self-management program referral. This includes individuals with conditions such as fibromyalgia, arthritis, back pain, or neuropathic pain.
2. Those seeking non-pharmacological pain management strategies: Pain self-management programs typically offer a range of non-pharmacological approaches to pain management. Patients who are interested in exploring alternative or complementary strategies beyond medication may find a referral to such programs beneficial.
3. Individuals struggling with pain-related functional limitations: People whose chronic pain interferes with their ability to engage in daily activities, work, or maintain a good quality of life may benefit from participating in a pain self-management program. These programs often aim to improve functioning and reduce the impact of pain on daily life.

In conclusion, filling out a pain self-management program referral involves providing patient and healthcare provider information, stating the reason for referral, attaching any necessary supporting documentation, and obtaining patient consent. Pain self-management program referrals may be appropriate for patients with chronic pain, those seeking non-pharmacological pain management strategies, and individuals struggling with pain-related functional limitations.

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What is pain self-management program referral?

Pain self-management program referral is a process where healthcare providers refer patients to programs that help them learn skills to manage their chronic pain.

Who is required to file pain self-management program referral?

Healthcare providers are required to file pain self-management program referrals for their patients who may benefit from such programs.

How to fill out pain self-management program referral?

To fill out a pain self-management program referral, healthcare providers need to document the patient's information, reason for referral, and any relevant medical history.

What is the purpose of pain self-management program referral?

The purpose of pain self-management program referral is to connect patients with resources and tools to better manage their chronic pain and improve their quality of life.

What information must be reported on pain self-management program referral?

Information such as patient demographics, medical history related to pain, reason for referral, and any other relevant details must be reported on a pain self-management program referral.