Pain History – Pain Scales

General & Administrative, Subjective/History Elements
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[select value="Patient|Caregiver"] <-- Rater
[select name="Q1" value="Numeric|FACES or Facial|FLACC"] <-- Pain Scale
[conditional field="Q1" condition="(Q1).is('Numeric')"][text] out of 10[/conditional][conditional field="Q1" condition="(Q1).is('FACES or Facial')"][html]<a href="" target="_blank">FACES Scale Site</a>[/html][text] out of 10[/conditional][conditional field="Q1" condition="(Q1).is('FLACC')"][select name="FLACC1" value="No particular expression or smile (0 points)=0|Occasional grimace or frown, withdrawn, uninterested (1 point)=1|Frequent to constant quivering chin, clenched jaw (2 points)=2"] <-- Face
[select name="FLACC2" value="Normal position or relaxed (0 points)=0|Uneasy, restless, tense (1 point)=1|Kicking, or legs drawn up (2 points)=2"] <-- Legs
[select name="FLACC3" value="Lying quietly, normal position, moves easily (0 points)=0|Squirming, shifting, back and forth, tense (1 point)=1|Arched, rigid or jerking (2 points)=2"] <-- Activity
[select name="FLACC4" value="No cry - awake or asleep (0 points)=0|Moans or whimpers; occasional complaint (1 point)=1|Crying steadily, screams or sobs, frequent complaints (2 points)=2"] <-- Cry
[select name="FLACC5" value="Content, relaxed (0 points)=0|Reassured by occasional touching, hugging or being talked to, distractible (1 point)=1|Difficult to console or comfort (2 points)=2"] <-- Consolability
[calc memo="score" value="(FLACC1)+(FLACC2)+(FLACC3)+(FLACC4)+(FLACC5)"] out of 10[/conditional]
[html]<hr>[/html][checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).is('')"][html]
reference: <a href="" target="_blank">FLACC Scale</a>, <a href="" target="_blank">FACES Scale Site</a>[/html][/conditional]
<-- Rater
<-- Pain Scale

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Result - Copy and paste this output:

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