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Pain Assessment Questionnaire  Form

Pain Assessment Questionnaire Form

Use a pain assessment questionnaire 0 template to make your document workflow more streamlined.

Your pain? Tingling/numbness in the hands/feet Weakness in the hands/feet Difficulty holding bladder or bowel movement Yes Yes Yes No No No 5. What triggers or makes your pain worse? ____________________ 6. What do you do to ease or relieve your pain? ______________________ TREATMENTS YOU HAVE TRIED 7. Which of the following treatments have you tried for your pain condition and what was the result? Acupuncture Biofeedback Exercise Herbal remedies Nerve block/epidural Physical...
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