Your life. Your plan.
Showing pain without words
Use the prompts that are helpful to you. You can write, draw, or ask someone to record your own words.
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The person and their contribution
Record how the person helped communicate or create this record. Name the observers and date it.
When comfortable or enjoying life
Describe familiar expressions, sounds, movements and responses. Avoid assuming one sign has the same meaning for everyone.
How I communicate pain, no or stop
Include known words, signs, objects, pictures, devices or other responses, and what remains uncertain.
What changed, and when?
Record exactly what was noticed, its time and the surrounding activity. Use another copy for a new observation if useful.
Possible explanations
Keep guesses separate from observations. Include questions for the clinician rather than deciding the cause yourself.
Health advice requested
Who was contacted, when, what information was shared and what advice was given?
Action and response
Record agreed care, treatment given as directed, and the person’s response afterwards.
Next steps and urgent-help plan
Who will review this and when? What changes mean seeking help sooner? Do not delay urgent help to complete this record.
Sharing and updating
Who needs this information, where is it kept, and who will keep it current?