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  • Patient Evaluation Form

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    Pavan Kumar
    9 views1 page
    This clinical reasoning reflection form is used to document a patient's pain assessment. It includes sections for the patient's details, chief complaint, subjective history, objective exam findings, pain characterization, diagnosis, hypothesized pain categories, key findings, precautions, contraindications, management, and prognosis. The therapist evaluates the relative contribution of factors like dysfunction, input/processing/output mechanisms, physical/environmental influences, and cognitive-affective components to form a hypothesis and guide treatment.

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    Original Title

    _PATIENT_EVALUATION_FORM

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    This clinical reasoning reflection form is used to document a patient's pain assessment. It includes sections for the patient's details, chief complaint, subjective history, objective exam findings, pain characterization, diagnosis, hypothesized pain categories, key findings, precautions, contraindications, management, and prognosis. The therapist evaluates the relative contribution of factors like dysfunction, input/processing/output mechanisms, physical/environmental influences, and cognitive-affective components to form a hypothesis and guide treatment.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    9 views1 page

    Patient Evaluation Form

    Uploaded by

    Pavan Kumar
    This clinical reasoning reflection form is used to document a patient's pain assessment. It includes sections for the patient's details, chief complaint, subjective history, objective exam findings, pain characterization, diagnosis, hypothesized pain categories, key findings, precautions, contraindications, management, and prognosis. The therapist evaluates the relative contribution of factors like dysfunction, input/processing/output mechanisms, physical/environmental influences, and cognitive-affective components to form a hypothesis and guide treatment.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    Pain- Clinical Reasoning Reflection form

    Patient’s name: Hospital no:


    Age: Gender: Male/ female
    C/C:

    S/E:

    O/E:

    Pain:
    Organic/ non-organic
    Constant/ intermittent/ both
    Localized/ generalized
    Superficial/ deep
    Somatic/ visceral
    Acute/ chronic
    Mild/ moderate/ severe intensity (VAS = /10cm)
    Mild/ moderate/ severe irritability

    Any specific diagnosis/ syndrome?

    Pain-Clinical reasoning:

    Hypothesis-categories Key finding(s)- maximum three (% Rating for each of them)


    1. General dysfunction
    2. Specific dysfunction
    3. Cognitive-affective
    dysfunction
    4. Input mechanisms
    5. Processing mechanisms
    6. Output mechanisms
    7. Source of symptoms- somatic/
    visceral
    8. Physical contributing factors
    9. Environmental/ergonomic
    contributing factors
    10. Cognitive-affective
    contributing factors
    11. Precautions for examination
    and/or treatment
    12. Contra-indications for
    examination and/or treatment
    13. Management
    14. Prognosis

    Any other comments:

    Signature of therapist

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