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 |
|---|---|---|---|---|---|
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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.