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  • Pain Assessment Form

Pain Assessment Form


Pain intensity can be measured with the following tool. It will help quantify pain on a scale of 1 to 10.


Fill out the table below to monitor pain progression.

Date Time Pain level Drug used to relieve pain Dose Pain level 1 hour
after administration of pain medication
           
           
           
           
           
           
           
           

© Copyright Vigilance Santé

The patient information leaflets are provided by Vigilance Santé Inc. This content is for information purposes only and does not in any manner whatsoever replace the opinion or advice of your health care professional. Always consult a health care professional before making a decision about your medication or treatment.

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