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PATIENT PAIN CHART Name___ Date___ Time___ am pm 1 Please draw your areas of involvement on the figures below and label the type or nature of the sensation of each area (i.e. pain, ache, numbness,

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How to fill out your pain on a

01

Start by identifying the type and intensity of your pain.

02

Locate the pain on the body (e.g. head, neck, back)

03

Use a pain scale to rate the intensity of your pain (e.g. 1-10)

04

Describe the characteristics of the pain (e.g. sharp, dull, throbbing)

05

Note any factors that worsen or alleviate the pain (e.g. movement, rest)

Who needs your pain on a?

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Individuals who are experiencing pain and want to effectively communicate their symptoms to healthcare providers.

02

Doctors, nurses, and other healthcare professionals who need accurate information to diagnose and treat the patient's condition.

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Who is required to file your pain on a?

The responsible party or individual who is experiencing the pain is required to file the pain on a.

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To fill out the pain on a, you must provide detailed information about the pain you are experiencing, including its location, duration, and intensity.

What is the purpose of your pain on a?

The purpose of reporting your pain on a is to document and track your discomfort or physical ailment for further evaluation and treatment.

What information must be reported on your pain on a?

You must report specific details about your pain, including when it started, what makes it worse or better, and any other symptoms that accompany it.

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