PainScaleList NoneToFrequentList 0To10List FirmSoftList LearningNeedsList EqualR>LL>Rlist
Long Names Short Names Long Names Short Names Long Names Short Names Long Names Short Names Long Names Short Names Long Names Short Names
0 None 0 None None 0 0 Firm Firm No Further Teach None Equal Equal
1 1 Rare Rare 1 1 Soft Soft Reinforce Freq Freq R>L R>L
2 2 Occasional Occ 2 2 Other*/Remark Other Reinfo Rationale Rationl L>R L>R
3 3 Frequent Freq 3 3 Needs Practice Practce Other*/Remark Other
4 4 Other*/Remark Other 4 4 ActivePassiveRefuseList Return Demo Demo
5 Moderate 5 5 5 Long Names Short Names Redo Teaching Redo PlanUnplanList
6 6 NoneToSevereList 6 6 Active Active Other*/Remark Other Long Names Short Names
7 7 Long Names Short Names 7 7 Passive Passive Planned Planned
8 8 None None 8 8 Refused Refused AddARemarkList Unplanned Unplan
9 9 Mild Mild 9 9 Unable Unable Long Names Short Names
10 Severe 10 Moderate Mod 10 10 Other*/Remark Other Add a Remark* Remark
Severe Severe
SymptomsEvalByList Other*/Remark Other WNL/Not WNLList PatientFamilyList FullTo16StrenghtList
Long Names Short Names Long Names Short Names Long Names Short Names Long Names Short Names
Pt Verbal Report Verbal OnOffList WNL/Pt Baseline WNL Patient Patient Full Strength Full 
Nods Head Yes/No NonVerb Long Names Short Names Not WNL Not WNL Family Family 3/4 Strength 3/4 Str
Physical Indices Physcal On On No ^ From Prior No ^ Patient & Family Pt&Fam 1/2 Strength 1/2 Str
Smile Chart S.Chart Off Off **************** . Caregiver Caregiv 1/4 Strength 1/4 Str
Other*/Remark Other Other*/Remark Other If Not WNL, add .. SO SO 1/8 Strength 1/8 Str
the Quick Row … Visitors Visitor 1/16 Strength 1/16Str
ApplicableNotApplicableList PositiveNegativeList Family for this …. Clergy Clergy Other*/Remark Other
Long Names Short Names Long Names Short Names system and chart ….. Other*/Remark Other
Applicable Applies Positive Pos the assessment. …… LightToHeavyList
Not Applicable N/A Negative Neg SymmetricalAsymetList Long Names Short Names
Other*/Remark Other Other*/Remark Other YesNoList Long Names Short Names Light Light
Long Names Short Names Symmetrical Symmet Medium Medium
BatteryCheckList PresentToAbsentList Yes Yes Asymmetrical Asymmet Heavy Heavy
Long Names Short Names Long Names Short Names No No Other*/Remark Other Other*/Remark Other
Checked Checked Present Present Other*/Remark Other
Replaced Replace Diminished Dimin ConsultNotifyList BarriersList
Other*/Remark Other Absent Absent InsertDClist Long Names Short Names Long Names Short Names
Other*/Remark Other Long Names Short Names Called Called No Barriers None
CurrentResolvedList Inserted Insert MD Requested MD Askd Culture Culture
Long Names Short Names SenttoLab Changed Changed Message Left Message Religious Religon
Current Current Long Names Short Names DC'D DC'D Not Applicable N/A Language Barrier Languag
Resolved Resolvd Sent To Lab Sent Pulled Out By Pt Pt Pull Done/In Chart Done Motivation Motivtn
From ED From ED Other*/Remark Other Psychological Psych
DoneNotDoneList SmallToLargeList From OR From OR Medications Meds
Long Names Short Names Long Names Short Names From Floor Frm Flr Q2ToQ8HourList Cognitive Limits Cognitv
Done Done Small Small Long Names Short Names Hearing Impaired Hearing
Not Done NotDone Medium Medium RegularIrregularList q2 Hours q2H Vision Impaired Vision
Other*/Remark Other Large Large Long Names Short Names q4 Hours q4H Finance Concerns Finance
Regular Regular q6 Hours q6H Neuro Deficit Neuro
ExcellentToNoneList StartStopDeferList Irregular Irreg q8 Hours q8H Illness Severity Illness
Long Names Short Names Long Names Short Names Other*/Remark Other Other*/Remark Other
Excellent Excell Start Start EqualR>LL>Rlist
Good Good Stop Stop Long Names Short Names OdorList InitiatedRenewedLIst
Adequate Adequat Resumed Resumed Equal Equal Long Names Short Names Long Names Short Names
Fair Fair Deferred Defer R>L R>L None None Initiated Initiat
Poor Poor L>R L>R Mild Mild Current Current
None None StrongToNoneList Other*/Remark Other Foul Foul Renewed Renew
Long Names Short Names Other*/Remark Other D/C'd D/C'd
InitiatedInUseList Strong     Strong NoneToCopiousList Other*/Remark Other
Long Names Short Names Average Average Long Names Short Names ClearCloudyList
Initiated Initiat Weak Weak None None Long Names Short Names IntactImpairList
In Use In Use None None Scant Scant Clear Clear Long Names Short Names
D/C'd D/C'd Small Small Cloudy Cloudy Intact Intact
IntactToAbsentList Moderate Mod Other*/Remark Other Impaired Impair
MetNotMetProcessList Long Names Short Names Large Large Other*/Remark Other
Long Names Short Names Intact Intact Copious Copious LowToHighList
Met Met Impaired Impair Other*/Remark Other Long Names Short Names OnOffOthList
Not Met*/Remark Not Met Absent Absent Low Low Long Names Short Names
FullToNoneList Medium Medium On  On
GoalProgress InOutList Long Names Short Names High High Off Off
Long Names Short Names Long Names Short Names Full Ful Other*/Remark Other Other*/Remark Oth
Goal Met Met In In Very Limited VL
Minimal Progress MinProg Out Out Slightly Limited SL
Moderat Progress ModProg None Non
Significant Prog SigProg ActualVsRiskList Other*/Remark Oth
No Progress NoProg Long Names Short Names
Other*/Remark Other > Risk For > Risk ContinuePlanList
Actual Problem Actual Long Names Short Names
Resolved Resolve Met Met
Other*/Remark Other Not Met/Continue NM/Cont
Not Met/DC Plan NM/DC
Other*/Remark Other
**************** .
If outcome "Not ..
Met" reevaluate …
plan & continue ….
or DC as approp …..