S.O.C.R.A.T.E.

S PAIN ASSESSMENT MODEL: RE-ASSESSMENT:

PEDIA:F.L.A.C.CAssessment(1mo-3yr)

S–Site Criteria 0 1 2
Whereisthe painlocated? No particular
Occasionalgrimace Frequentto
FACE or frown, constantquivering
expression or withdrawn,Unintere of chin,clenched
smile sted jaw
O-Onset
Whendidthepainstarted? Normalposition Uneasy,restless, Kicking,orlegs
LEGS or relaxed tense drawn up

C- Characteristic Lying quietly, Squirming,shifting

ACTIVITY normalposition, back and Arched, rigid or
Flickering Pinching moveseasily forth,tense jerking
Gnawing Radiating
Pulsating Cramping Moansor Cryingsteadily,
whimpers; screamsor
Throbbing Crushing CRY
Nocry (Awake occasional sobs,frequent
Pounding Pressing or asleep) complaint complaints
Tingling Dull
Reassuredby
Itchy Penetrating occasionaltou
Sore Sharp CONSOLABILITY Context,relaxed ching,huggin Difficultto console
Burning Squeezing g, or or comfort
beingtalkedto
Numbness Stabbing
UnbearableOTHERS: PEDIA:WONG-BAKERSCALE(3yr-7yr)

R -Radiation
Does thepain goanywhere else?

A -Associated symptoms

ADULT:(>7yrandabove)
T-Time/duration
Forhow longdoes thepainlasts?
□Intermittent
□Constant
E-Exacerbating/relievingfactors
ExacerbatingFactors RelievingFactors

RE-ASSESSMENTREMARKS:

S-Severity(UsingWONG-BAKER SCALE)
Minimum PainTolerance UnbearablePainScale

Examiner’ssign:

PAINASSESSMENTANDRE-ASSESSMENT

LAST NAME FIRST NAME (Suffix e. g. Jr.) MIDDLE NAME CASE NO. REGISTRATION NO.