By signing below, I acknowledge that I have read through the above information, and confirm understanding and compliance.
Use the illustration to fill out pain assessment.
Now indicate the amount of pain you have for each area:
Use PAIN AREA to indicate where pain is coming from.
Use SIDE to indicate if pain is on front, back, left, or right side of body.
Use PAIN LETTER to indicate A = ache, B= burning, N=numbness, S= stiffness, T=tingling, Z=sharp/shooting.
Use PAIN LEVEL to rate pain from 1-10. - 0 being no pain, and 10 being maximum pain.
Example: Pain Area: Neck | Side: Left | Pain Letter: S | Pain Level: 3
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If you have questions about the contents of this document, you can email the document owner.
Document Name: Lisa Test
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