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)
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