Assessment & Plan Elements
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C/o [select value="10|9|8|7|6|5|4|3|2|1|0|Severe|Moderate|Mild"] out of 10 pain
Pain orientation
[checkbox value="right|left|anterior|distal|inner|lower|mid|outer|posterior|proximal|upper|other"] [select value="abdomen|ankle|arm|back|breast|buttocks|chest|coccyx|ear|elbow|epigastric|extremity|eye|face|flank|foot|generalized|groin|hand|head|hip|incision|jaw|knee|leg|mediastinum|mouth|neck|nose|perlvis|perineum|penis|pretibia|rib cage|rectum|sacrum|sclera|shoulder|scrotum|sternum|tibia|throat|teeth|umbilicus|uterine|vagina|wrist"]
[checkbox value="Radiating towards__"]
[select value="acute pain|chronic pain|surgical pain|neuropathic pain|phantom pain|referred pain"]
[select value="awakened from sleep|gradual|ongoing|progressive|sudden|unable to tell"] onset
Exacerbated by [select value="bending|coughing/breathing|exercise|kneeling|reposition/movement|palpation/touch|squatting|standing|straightening|stretching|walking"]
Alleviated by [select value="Meds|Rest"]
Pain interventions [checkbox value="Medication (see MAR)|heat applied|cold applied|compression|reposition|declines|MD notified (comment)|distraction|elevated|emotional support|environmental changes|food|massage|music|prayers|relaxation technique|rest"]
Resident's stated pain goal [select name="Goal" value="No pain|1|2|3|4|5|6|7|8|9|10|No pain - 0|Mild 1-3|Moderate 4-6|Severe 7-10|unable to assess r/t condition"]
C/o out of 10 pain
Pain orientation



onset
Exacerbated by
Alleviated by
Pain interventions
Resident's stated pain goal

Result - Copy and paste this output: