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How to use or fill out Initial Pain Evaluation Form - Phoenix Thera-Lase Systems with DocHub
- Click ‘Get Form’ to open it in the editor.
- Begin by entering the date and your personal information, including last name, first name, and middle initial. This ensures that your evaluation is properly documented.
- Answer the first question regarding your ability to walk unassisted by selecting 'YES' or 'NO'.
- Indicate your average activity level by choosing from Light, Moderate, or Vigorous. Refer to the provided examples for clarity.
- Respond to whether you have experienced pain beyond everyday types today by selecting 'YES' or 'NO'.
- Use the diagram provided to shade areas of pain and number them accordingly. Mark the area that hurts the most with an 'X'.
- Rate your current pain level by circling a number on the scale from 0 (No Pain) to 10 (Bad Pain) for each identified pain area.
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