Visual Analog Scale Pain Indicator Chart

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Visual Analogue Scale (VAS) Pain Indicator Chart
Patient’s Name: ________________________________________________________________
Reference Record #: ____________________________________________________________
Tel: (home) ________________________
(Mobile) ___________________________________
Date of Birth: ____________________________
Gender:
Male
Female
Indicate your pain level on the scale below.
The W o r st Im a gina b le P ain
No P ain

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Parent category: Education
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