Transcription of PAIN AND SYMPTOM MANAGEMENT LOG - MI Holistic Health
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PAIN AND SYMPTOM MANAGEMENT LOG - MI Holistic Health
DATE TIME What are you doing working, driving, trying to sleep? IF TRACKING pain , WHERE DOES IT HURT? Number your SYMPTOM from 1-10 (1=slightest,10=worst)What, if anything, do you do or take for SYMPTOM control at this time? (You may tell us if you are using marijuana.) Number your SYMPTOM (1-10) 1 hour after treatment Nam e _____ _____ _____ Condition _____ Date of birt h _____ Please print several sheets and record 2-3 entries EVERY DAY until your appointment. Rev 11/2016 pain AND SYMPTOM MANAGEMENT LOG
10 (1=slightest, 10=worst) What, if anything, do you do or take for symptom control at this time? (You may tell us if you are using marijuana.)
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