Mild pain that is predictable and/or is having a moderate effect on other domains Moderate pain or other symptoms which is/are associated with certain activities of daily or on the provision of care. having a significant effect on other domains or living; pain and other symptoms do not on the provision of care. have an impact on the provision of care. Brief description Write A, B or C of need and below: source of evidence to support the chosen level Name of individual Date of completion C B A
Mild pain that is predictable and/or is associated with certain activities of daily living; pain and other symptoms do not have an impact on the provision of care. having a moderate effect on other domains or on the provision of care. Moderate pain or other symptoms which is/are having a significant effect on other domains or on the provision of care. Brief description of need and source of evidence to support the chosen level Write A, B or C below: Name of individual Date of completion C B A
NHS_continuing_healthcare_checklist_-_October_2018_revised.docx