Numeric Rating Scale Pain Indicator Chart Template
ADVERTISEMENT
1Numeric Rating Scale - Pain Indicator Chart
Patient’s Name: ________________________________________________________________
Reference Record #: ____________________________________________________________
Tel: (home) ________________________
(Mobile) ___________________________________
□
□
Date of Birth: ____________________________
Gender:
Male
Female
Indicate your pain level here
Scale
Comments / Notes
20
19
18
17
16
15
14
13
12
11
10
9
8
7
6
5
4
3
2
1
0
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Education