Pain Management Resources



Chronic Pain Management Guidelines (PDA-formatted pdf version)
Template for Chronic Pain Patients at Pain Rounds (courtesy of Barre Family Health Center)
Summary of Chronic Pain residency project as presented at Fall 2009 faculty retreat


Family Health Center of Worcester Forms for Use in Patient Visits

Initial visits

Patient/Provider Pain Medication Agreement forms:
Albanian
English
Portugese
Spanish
Vietnamese

Baseline forms completed by patient: (Copyright 1991 Charles S. Cleeland, Ph.D, Pain Research Group,
                                                              Used by permission.)

Albanian
English
Portugese
Spanish
Vietnamese

Clinician Intake and Assessment form     


Follow-up visits


Progress note completed by provider

Follow-up forms completed by patient:
Albanian
English
Portugese
Spanish
Vietnamese


Alternative Resources for Chronic Pain Patients


Resources for Barre Family Health Center
Resources for Family Health Center of Worcester
Resources for Hahnemann Family Health Center 
 

To order UMMHC-approved forms:

 
If you would like to order the English language UMMHC-approved versions of these forms, please do so through the Forms Management website at 508-793-6487.  Multi-lingual form ordering information will be posted on this page when available.      

 

         Form Number        

 Name of Form

 NS FCM0005

FCM Pain Management Intake Form 

 NS FCM0006

FCM Opiate Medication Agreement 

 NS FCM0007

 FCM Patient Baseline Assessment Packet

 NS FCM0008

FCM Patient Satisfaction Survey 

 NS FCM0009

FCM Patient Pain Progress Note

NS FCM0010 

FCM Pain Management Follow-Up (Brief Inventory)