InternalDamage Pain Assessment
__________
Instructor:mz menzchine
Name: ________
Date: _________
Condition(if diagnosed):__________________
Please createa hardcopy of this sheet before commencing
answeringthe questions. Read each questioncarefully,
then circlethe letter of the correct answer on the line
next toit. When completed,file the form in an appropriate
locationfor future reference.
1. Is therean absence of pain regarding the specified
internaldamage?
a. Yes
b. No
c. Other[how do you quantify states not obvious to
the nakedeye? a shark-skinned touch...a lathering of
steelwoolwords grating...a chilling slap to your present
sense ofspace and time]
2. Doesthe pain have a definable/recognizable
source (e.gan open wound, tender spot, etc)?
a. Yes
b. No
c. Maybe[...once fleshfilled hormone sparks that now
rip throughyour psychic skin and cerebral bones....]
3. Is thepain constant?
a. Yes
b. No
c. Unsure[is unseen pain the better option? Bear with
it - gritand grind your pearly whites until they paint
your mouthwith red...bite or swallow your tensile
tongue...and all the while just grimace and purr
and staticyour insides with mellow shades of numb
...he won'tnotice your frisking acting state...
you will cushion all...no effect, no affect]
4. Is thepain:
a. Mild
b. Moderate
c. Severe [severely sever effective ties and bows
and learnto live with graphic states of pain].
Thank you for participating.
