As the health care industry's most comprehensive library of customizable policy and procedure templates, MCN Healthcare's Administrative Manual for Ambulatory Care Facilities includes this customizable template, Pain Management Program - Initial Pain Assessment Form. MCN's policy library helps you meet compliance with Joint Commission and federal regulations including CMS, CDC, OSHA, OIG, HIPAA and more.

MCN's templates save you time, money and resources, rather than developing healthcare policy and procedure manuals from scratch.

Here is some sample content from Pain Management Program - Initial Pain Assessment Form:

	PAIN MANAGEMENT PROGRAM INITIAL PAIN ASSESSMENT FORM Patient Name: DOB: Date: Physician: Diagnosis: Describe Location of Pain: Pain Scale Rating: Pain Currently Rated At: What is the Worst Pain Gets? What is the Best Pain Gets? What is an Acceptable Level of Pain? What is the Quality of the Pain? Have Patient Describe in Own Words: Onset: Duration: Variations: Manner the Patient Uses to Express Pain: What Relieves Patient's Pain? i.e., heat, rest, medication What Causes or Increases Patient's Pain? i.e., walking, standing, lifting, exercise What Effects Does Pain Have...
Second excerpt:
	... Physical Activity: Relationships With Others: Emotions: Concentration: Sleep: Other: Check the words that describe the patient's pain: ? aching ? intermittent ? shooting Describe Any Previous or Ongoing Instances of Pain: What Previous Methods of Pain Control Have Been Helpful? What Previous Methods of Pain Control Have Not Been Helpful? How Does Patient Feel About the Use of Opioid, Anxiolytic or Other Medications? Does Patient Have History of Substance Abuse: Does...