Pain Assessment Form Page 2
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3PAIN ASSESSMENT
BODY CHARTS
A body chart is a visual tool for mapping location of pain, and marking with pen areas of severe pain, and
areas of moderate or mild pain.
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left
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NUMERIC PAIN INTENSITY SCALE
Numerical scales are also useful for rating severity of pain.
0
2
4
6
8
10
No Pain
Mild
Moderate
Severe
Very
Worst
Pain
Pain
Pain
Severe
Possible Pain
Pain
THE WONG BAKER PAIN INTENSITY SCALE
This is often used in clinical practice and may be simplified into no pain, moderate pain and severe pain.
Ask or indicate to the patient that you require him/her to point to the face which best describes his/her
current level of pain/comfort. Assessment must include date, time, and signature of the person making the
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assessment
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HELP US TO HELP YOU
0
1
2
4
5
6
10
NO
MILD
MODERATE
SEVERE
VERY
WORST
PAIN
PAIN
PAIN
PAIN
SEVERE
POSSIBLE
PAIN
PAIN
March 2017
Page 2 of 3
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Parent category: Life