Tag Pain

BC, Chronic Pain, eForms, Fraser Health Authority, Neurology

Initium CPM referral

Initium Centre for Pain Medicine referral eForm. Created at the request of the Chilliwack Division of Family Medicine.

John Robertson
June 22, 2021

BC, Chronic Pain, Clinical Counselling, Communication with Patient, Decision Tools, eForms, Fraser Health Authority, Outpatient

Community Pain Management Program Fraser Health

for referral to Fraser Health’s Community Pain Management Program. Has links to the Fraser Health Version of the Brief Pain Index and the Primary Care Provider Patient Summary.

John Robertson
October 11, 2020

BC, Chronic Pain, Clinical Counselling, Communication with Patient, Decision Tools, eForms, Fraser Health Authority

BPI Short Form Fraser Health Pain Clinic

Updated 2020-Oct-13 06:36 drawing code hived off, calculations updated, previous values pulled. Please not in order to pull previous values add measurements must be made. Based on the form by Charles S. Cleeland PhD and the Pain Research Group. The…

John Robertson
October 11, 2020

BC, Chronic Pain, eForms, Mental Health, Neurology, Vancouver Island Health Authority

VIHA Outpatient Pain Management Referral 2020

Created by Dr. Ian Bekker. Referral form for the Outpatient Pain Management Clinics run by Vancouver Island Health Authority. I have made some modifications: radio X-boxes, increase or decrease font size in textarea, added placeholders, added links to other parts…

John Robertson
April 17, 2020

Chronic Pain, Communication with Patient, Decision Tools, eForms, History Taking, Mental Health, Screening

Pain Disability Index ( PDI ) V2 2019

Updated by Gunther Klein to improve printing output. Pure HTML file to be uploaded (not imported). Saved as a .html.txt file so that it would upload to this site. Once you have downloaded it, remove the .txt from the end…