Form preview

Get the free Pictorial Blood Assessment Chart and

Get Form
Figure 1. Pictorial Blood Assessment Chart and Scoring System for Assessment of Menstrual Blood Loss How to use the PAC scoring system: During the course of your period record your use of tampons
We are not affiliated with any brand or entity on this form

Get, Create, Make and Sign pictorial blood assessment chart

Edit
Edit your pictorial blood assessment chart form online
Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.
Add
Add your legally-binding signature
Draw or type your signature, upload a signature image, or capture it with your digital camera.
Share
Share your form instantly
Email, fax, or share your pictorial blood assessment chart form via URL. You can also download, print, or export forms to your preferred cloud storage service.

How to edit pictorial blood assessment chart online

9.5
Ease of Setup
pdfFiller User Ratings on G2
9.0
Ease of Use
pdfFiller User Ratings on G2
To use our professional PDF editor, follow these steps:
1
Log in to account. Click on Start Free Trial and register a profile if you don't have one yet.
2
Prepare a file. Use the Add New button. Then upload your file to the system from your device, importing it from internal mail, the cloud, or by adding its URL.
3
Edit pictorial blood assessment chart. Rearrange and rotate pages, insert new and alter existing texts, add new objects, and take advantage of other helpful tools. Click Done to apply changes and return to your Dashboard. Go to the Documents tab to access merging, splitting, locking, or unlocking functions.
4
Get your file. When you find your file in the docs list, click on its name and choose how you want to save it. To get the PDF, you can save it, send an email with it, or move it to the cloud.
With pdfFiller, it's always easy to work with documents.

Uncompromising security for your PDF editing and eSignature needs

Your private information is safe with pdfFiller. We employ end-to-end encryption, secure cloud storage, and advanced access control to protect your documents and maintain regulatory compliance.
GDPR
AICPA SOC 2
PCI
HIPAA
CCPA
FDA

How to fill out pictorial blood assessment chart

Illustration

How to fill out pictorial blood assessment chart

01
To fill out the Pictorial Blood Assessment Chart, follow these steps:
02
Start by placing the patient's name and date at the top of the chart.
03
Observe the five different types of blood loss depicted on the chart: spot, light stain, moderate stain, large stain, and massive bleeding.
04
Assess the patient's condition and determine which category of blood loss best represents the current situation.
05
Mark the corresponding category on the chart by coloring the circle next to it.
06
Take note of the total number of categories marked and record it in the designated area.
07
Optionally, use the body outline on the chart to indicate the specific location of the bleeding if relevant.
08
Review the chart to get an overall assessment of the patient's blood loss.
09
Use this assessment to communicate with medical professionals and assist in treatment decisions.

Who needs pictorial blood assessment chart?

01
The Pictorial Blood Assessment Chart is useful for any individual who may experience or encounter blood loss in various situations, including:
02
- Healthcare professionals who need a quick visual tool to assess the severity of blood loss in patients.
03
- First responders and emergency medical personnel who want a standardized way to communicate about blood loss.
04
- Individuals who are at risk of excessive bleeding or need to self-monitor their blood loss, such as hemophiliacs or post-operative patients.
05
- Training programs and simulations where realistic blood loss assessment is required.
06
- Researchers and educators studying or teaching about blood loss and its impact on health.
07
The chart can be utilized in various healthcare settings, including hospitals, clinics, ambulances, and training facilities.
Fill form : Try Risk Free
Users Most Likely To Recommend - Summer 2025
Grid Leader in Small-Business - Summer 2025
High Performer - Summer 2025
Regional Leader - Summer 2025
Easiest To Do Business With - Summer 2025
Best Meets Requirements- Summer 2025
Rate the form
4.5
Satisfied
55 Votes

For pdfFiller’s FAQs

Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.

Use pdfFiller's Gmail add-on to upload, type, or draw a signature. Your pictorial blood assessment chart and other papers may be signed using pdfFiller. Register for a free account to preserve signed papers and signatures.
Use the pdfFiller mobile app to create, edit, and share pictorial blood assessment chart from your iOS device. Install it from the Apple Store in seconds. You can benefit from a free trial and choose a subscription that suits your needs.
The pdfFiller app for Android allows you to edit PDF files like pictorial blood assessment chart. Mobile document editing, signing, and sending. Install the app to ease document management anywhere.
The Pictorial Blood Assessment Chart (PBAC) is a tool used to visually assess menstrual blood loss.
Healthcare providers may be required to file the PBAC for patients with heavy menstrual bleeding.
The PBAC is filled out by visually comparing menstrual blood loss to pictures of blood loss on the chart.
The purpose of the PBAC is to help quantify and monitor menstrual blood loss in patients.
The PBAC records the amount of menstrual blood loss using visual images on a scale.
Fill out your pictorial blood assessment chart online with pdfFiller!

pdfFiller is an end-to-end solution for managing, creating, and editing documents and forms in the cloud. Save time and hassle by preparing your tax forms online.

Get started now
Form preview
If you believe that this page should be taken down, please follow our DMCA take down process here .
This form may include fields for payment information. Data entered in these fields is not covered by PCI DSS compliance.