Personal Documentation of Injury or Condition
To better assist us during your appointment with one of our orthopaedic doctors, we encourage our patients to complete a personal documentation of injury or condition. The following information is intended to help you when completing this document about your personal injury/condition:
- Date of injury or onset of condition
- Precise location of injury or condition
- Activity you were doing prior to or during the onset of the injury or condition
- Documentation of other medical treatment you received with regard to this injury or condition
- Home remedy treatments you have tried
- Description of pain—the following words are helpful in properly diagnosing the cause of your pain:
- Aching
- Sharp
- Dull
- Penetrating
- Throbbing
- Tender
- Nagging
- Shooting
- Burning
- Stabbing
- Exhausting
- Numb
- Gnawing
- Tiring
- Unbearable
- Occasional
- Continuous
- Note the time(s) of day that your pain is usually at its worst, and rate your pain on a scale of 0 – 10. (0 = No Pain and 10 = Unbearable Pain)
- Note the time(s) of day that your pain is usually at its least, and rate your pain on a scale of 0 – 10. (0 = No Pain and 10 = Unbearable Pain)
- Rate your level of pain on a scale of 0 – 10 when you do one or more of the following activities:
- Laying down
- Sitting
- Standing
- Walking
- Running
- Lifting
- Bending over
- Pulling
- Pushing
- Driving
- Note any other activities you do that make you feel better or worse.
- Note any side effects or symptoms you are having caused by your injury or condition. The following are examples of common side effects caused by pain:
- Nausea
- Vomiting
- Constipation
- Loss of appetite
- Fatigue
- Sweating
- Difficulty concentrating
For questions about the personal documentation of injury or condition document or how to better prepare for your appointment, please call 850-863-2153.