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292 - PAIN DRAWING 072004 - Physical Therapy

292 - PAIN DRAWING 072004 - Physical Therapy 2026

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The document is a pain assessment form for patients to indicate their symptoms and rate their pain levels. It includes a diagram for marking symptom locations and a scale for rating pain intensity at the present moment, worst, and best over the past 24 hours.

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Click ‘Get Form’ to open the 292 - PAIN DRAWING in the editor.
Begin by entering your name and the date at the top of the form. This personal information is essential for your physical therapy records.
Use the diagram provided to indicate where you feel symptoms. Select from the key provided: 'Pins and needles' (000000), 'Burning' (xxxxxx), 'Stabbing' (/ / / / / /), or 'Deep Ache' (zzzzzzz) to mark your symptoms accurately.
Next, rate your pain over the past 24 hours using the three scales. For each scale, mark your current pain level, as well as your worst and best pain levels during this period, using a scale from 0 (No Pain) to 10 (Extremely Intense).

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