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Pediatric Chronic Pain Program Referral Form Physician/Nurse Practitioner Referral OnlyReferral Date: INCLUSION CRITERIA Under 17 at time of referralChronic pain as a primary complaintChronic pain
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How to fill out pediatric chronic pain program

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How to fill out pediatric chronic pain program

01
Start by gathering all necessary information about the pediatric patient, including their medical history, current symptoms, and any previous treatments they have undergone.
02
Assess the patient's pain level and any associated physical or emotional factors that may be contributing to their chronic pain.
03
Develop a comprehensive treatment plan that addresses both the physical and emotional aspects of the child's pain.
04
Create a schedule for therapy sessions, medication administration, and any other necessary interventions.
05
Educate the child and their family about the nature of chronic pain and the importance of adhering to the treatment plan.
06
Monitor the child's progress regularly and make any necessary adjustments to the treatment plan.
07
Collaborate with a multidisciplinary team of healthcare professionals to provide holistic care for the child's chronic pain.
08
Provide ongoing support and resources to the child and their family to help manage the challenges associated with pediatric chronic pain.

Who needs pediatric chronic pain program?

01
Pediatric patients who are experiencing chronic pain that has lasted for an extended period of time.
02
Patients who have tried other treatment options for their chronic pain without significant relief.
03
Children who have experienced traumatic events or have underlying psychological factors that contribute to their chronic pain.
04
Families who are seeking a comprehensive and interdisciplinary approach to managing their child's chronic pain.
05
Healthcare providers who specialize in pediatric pain management and are knowledgeable about the unique needs of children with chronic pain.
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The pediatric chronic pain program is a specialized program designed to help children and adolescents manage and reduce their chronic pain.
Healthcare providers and facilities that specialize in treating pediatric chronic pain are required to file the program.
The program can be filled out by providing detailed information about the patient's medical history, pain symptoms, and treatment plan.
The purpose of the program is to improve the quality of life for children and adolescents suffering from chronic pain by providing specialized care and treatment.
Information such as the patient's age, medical history, pain symptoms, treatment plan, and progress must be reported on the program.
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