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Time test perfomed
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Resting Pulse Rate
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Sweating (over past 1/2 hour not accounted for by room temp or patient activity
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Restlessness (observation during assessment)
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Pupil Size
|
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Bone or Joint Aches (only component related to opiate withdrawal)
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Runny nose or tearing (in absence of cold or allergies)
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GI upset (or previous half hour)
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Tremor (observation of outstretched hands)
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Yawning (observation during assessment)
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Anxiety or Irritability
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Gooseflesh skin
|
|
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Total Score
|
|
|
Severity- Mild <13, Moderate 13-24, Moderately Severe 25-36, Severe >36
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Assessor
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