|
Pain Diagram
|
|
|
Chief Complaint
• • •
|
CC status
|
|
% of day?
|
Other Symptoms
• • •
|
|
Severity of pain
|
Quality of pain
• • •
|
|
Radiate?
|
If yes, Where?
|
|
Palliative
• • •
|
Provocative
• • •
|
|
Comments related to ADL's
|
|
|
Secondary Complaint
|
Secondary Status
|
|
% of the Day
|
Severity
|
|
Quality of the Pain
• • •
|
|
|
Day 1-12
|
Day 12-24
|
|
Adult Wellness 1-6
|
Paediatric Wellness
|
|
Children 1-12
|
Children 12-24
|
|
Re-Exam
|
|
