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Attachment B OP140146OKLAHOMA DEPARTMENT OF CORRECTIONS Edmonton Symptom Assessment System Numerical Scale Please circle the number that best describes: No Pain Worst Pain 0 1 2 3 4 5 6 7 8 9 10Not
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How to fill out edmonton symptom assessment system

01
To fill out the Edmonton Symptom Assessment System (ESAS) form, follow these steps:
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Start by printing or obtaining a copy of the ESAS form.
03
Locate a quiet and comfortable space where you can focus on filling out the form.
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Begin by providing your basic demographic information, such as your name, age, gender, and date of assessment.
05
Look at the list of nine symptoms provided on the form, which include pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, well-being, and shortness of breath.
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For each symptom, rate your level of severity from 0 (no symptom) to 10 (worst imaginable symptom). Consider how the symptom is affecting you at the present moment.
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Use the provided numerical scale to indicate your rating for each symptom. Make sure to mark the corresponding number accurately.
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If there are any additional symptoms you are experiencing that are not listed, you can write them down in the 'Other Symptoms' section.
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Once you have rated all the symptoms and provided any additional information, review your answers to ensure they are accurate and complete.
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Finally, sign and date the form at the bottom to complete the process of filling out the ESAS form.
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Note: If you have any questions or need assistance while filling out the form, it is advisable to consult a healthcare professional or the relevant medical staff.

Who needs edmonton symptom assessment system?

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The Edmonton Symptom Assessment System (ESAS) is useful for individuals who:
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- Have been diagnosed with a serious illness or condition
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- Experience symptoms related to their illness or condition
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- Want to track and communicate their symptom severity to healthcare professionals
05
- Are undergoing various treatments or therapies and need to assess the effectiveness of the interventions
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- Wish to have a systematic and standardized way of self-assessing their symptoms
07
ESAS can be particularly helpful for patients with cancer, palliative care patients, individuals with chronic illnesses, and those receiving end-of-life care. However, it can also be beneficial for any individual who wants to monitor and manage their symptoms in a structured manner.
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The Edmonton Symptom Assessment System (ESAS) is a tool used to assess the severity of nine common symptoms experienced by patients with cancer.
Healthcare providers, including nurses, doctors, and other medical professionals, are required to use the ESAS to monitor and track patients' symptoms.
To fill out the ESAS, healthcare providers ask patients to rate the severity of their symptoms on a scale of 0 to 10, with 0 being no symptoms and 10 being the worst possible symptoms.
The purpose of the ESAS is to help healthcare providers identify and address symptoms that may be affecting a patient's quality of life.
The ESAS requires patients to report the severity of symptoms such as pain, fatigue, nausea, depression, anxiety, drowsiness, appetite, well-being, and shortness of breath.
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