Pain Assessment Record

📋 This is what you get — complete pain assessment, print-ready

Scored, documented, signed. Free. No login. No data stored. No catch.

EXAMPLE OUTPUT

PAIN ASSESSMENT RECORD

Patient:Margaret Sullivan | MRN-004821

Ward / Bed:4B — Bed 4

Assessed:13/03/2026 14:30

Pain Score:7 / 10 — MODERATE–SEVERE

Location:Right lower abdomen, radiating to back

Quality:Burning, Aching, Constant

Onset:Gradual, onset 2 days ago

Duration:Continuous

Aggravating:Movement, deep breathing

Relieving:Rest, IV morphine (partial relief)

Current Analgesia:IV Morphine 2mg PRN, Paracetamol 1g QID

Functional Impact:Unable to mobilise independently

INTERVENTIONS: ✓ Analgesia administered ✓ Position change ✓ MO notified ✓ Heat pack applied

Assessed by:J. Chen RN — AHPRA: NMW0001234567

👇 Fill the form below — your assessment builds live as you go.

Clinical Reference:
Numeric Rating Scale (NRS) and Visual Analogue Scale (VAS) are widely validated pain assessment tools used internationally in clinical practice.
McCaffery M, Beebe A. Pain: Clinical Manual for Nursing Practice. CV Mosby; 1989.

INTERVENTIONS — tick all performed

Analgesia administered

Position change / repositioning

Medical officer notified

Heat / cold pack applied

Non-pharmacological measures

Referral made (physio / pain team)

Patient education provided

Reassessment scheduled

Pain Assessment Record

📋 This is what you get — complete pain assessment, print-ready

HOW IT WORKS

PATIENT INFORMATION

PAIN SCORE — NUMERIC RATING SCALE (NRS)

PAIN QUALITY — tick all that apply

PAIN CHARACTERISTICS

CURRENT MANAGEMENT

INTERVENTIONS — tick all performed

NURSE SIGN-OFF

📄 YOUR ASSESSMENT — Updates live as you fill the form above