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Worksheets/Psychoeducation

Chronic Illness Pain Check in

Fill out this check in 1x daily to create more awareness of body sensations and evaluate pain and symptoms over time

Assign it in PrecisionMind Make your own version

Are you feeling pain right now? if so how much

no painvery minor annoyance-- occasional minor twingesminor annoyance -- occasional strong twingesannoyance enough to be distractingcan be ignored if you are really involved in your work but still distractingcan't be ignored for more than 30 minutesmakes it difficult to concentrate, interferes with sleep, you can still function with effortphysical activity severely limited. you can read and converse with effort, nausea na dizziness set in as factors of painunable to speak, crying out or moaning uncontrollably near deliriumunconscious, pain makes you pass out, strongest painkillers are only partially effective

do you feel tiredness, weakness (fatigue, tired but awake) right now?

noa little bitits hard to pay attentionits hard to pay attention, I want/need to sitits hard to pay attention, I want/need to lie down

do you feel like you want to go to sleep right now?

noa little bitits hard to pay attentionits hard to stay awakeneed to sleep now

how well are you thinking right now?

okhaving some difficulty focusinghard to focusextremely hard to focus, but can preform daily activitiescan't focus to do personal care/activities of daily living

are you having any trouble moving/walking right now

noa little bitdon't feel like walkingcan move or walk with effortcan't move or walk

how is your mood right now

very content / satisfiedsomewhat satisfiedhanging in (glass half empty / half full)somewhat stressed or irritablevery stressed or irritable

activities done today

errandsworkexercisehouse choresyard workkiddo activities / responsibilitiesleisure activitiesself care practices

Other notes

How clinicians use it

1
Introduce it in session
Walk through the first section together so the client knows what a full answer looks like. Five minutes here saves a blank sheet next week.
2
Send it home
Assign it from the client's chart. They complete it in their app, and the responses land back in your notes without anyone re-typing anything.
3
Review and adjust
Open the completed sheet alongside your note, mark what shifted, and fold it into the treatment plan if it is worth repeating.

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