Date and time (control+d) :
Level of pain =
|-----|-----|-----|-----|-----|-----|-----|-----|-----|-----|
0 1 2 3 4 5 6 7 8 9 10
0= No pain
10=Worst pain imaginable
Quality of Life function number (from Quality of Life Pain Management page) =
√ General mood (√ all that apply or add your own) :
Upbeat
Rested
Relaxed
Feeling sociable
Healthy appetite
Optimistic
Tired
Depressed
Angry
Burdened
Worried
Lonely
Stressed
NOTES :
(Narratives, comments, strategies, appointment reminders, doctor's comments, inspirational quotes, website links, etc)
