20. ( ) ( ) Establishes or confirms the complaint or reason for the visit. Yes No 21. ( ) ( ) Location of pain Yes No 22. ( ) ( ) Radiation of pain Yes No 23. ( ) ( ) Other symptoms associated with the pain: Yes No 24. ( ) ( ) Character of pain. Yes No 25. ( ) ( ) Alleviating factors. Yes No 26. ( ) ( ) Aggravating factors. Yes No 27. ( ) ( ) Timing of pain. Yes No 28. ( ) ( ) Precipitant or environment/context in which pain occurs. Yes No
20. Establishes or confirms the complaint or reason for the visit. ( ) Yes ( ) No 21. Location of pain ( ) Yes ( ) No 22. Radiation of pain ( ) Yes ( ) No 23. Other symptoms associated with the pain: ( ) Yes ( ) No 24. Character of pain. ( ) Yes ( ) No 25. Alleviating factors. ( ) Yes ( ) No 26. Aggravating factors. ( ) Yes ( ) No 27. Timing of pain. ( ) Yes ( ) No 28. Precipitant or environment/context in which pain occurs. ( ) Yes ( ) No
Jenny%20Jones%20v2017%20sample%20checklist.docx