Template library · Assessments & screeners
Pain Management Follow-Up template
Complete at each follow-up visit to track pain trajectory and treatment response.
Follow-up review for clients in active pain management
- 15 fields across 4 sections
- Included with MyWellOps
- Edit it, or save your own version
What’s in it
Assessment Details
- Client NameText
- Date of BirthDate
- Client ID / MRNText
- Date of AssessmentDate
- Clinician / CoachText
- Location / ModalityText
Pain Level Since Last Visit
- 1. Average pain levelChoice
- 2. Worst pain levelChoice
- 3. Pain interference with sleepChoice
- 4. Pain interference with activityChoice
Clinical Notes
- Response to current treatment planText
- Side effects reportedText
- Plan for next visitText
Signatures
- Clinician SignatureSignature
- Date signed (clinician)Date
When to use it
Use an assessment at the start of work to set a baseline, then repeat it at review points so you and the client can see what has changed.
How it works in MyWellOps
- Pick it from Documents.
- Send it to the client to complete, or fill it in together during a session.
- Each completed copy is kept on the client’s record, so earlier results are there to compare.
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