Pain Assessment — FHIR Questionnaire Template

Pain severity on a 0–10 scale, location, onset and a free-text description.

Scoring

No scoring — severity is recorded as a 0–10 number.

Questions

1. Pain severity right now (0 = no pain, 10 = worst pain imaginable)
2. Where is the pain?
3. When did the pain start?
4. Describe the pain (for example sharp, dull or burning)

Source and license

Source: Original wording written for this builder.

License: Original wording written for this builder; covered by the project license (non-commercial use with attribution; commercial use needs written permission). (link)

Provided to save authoring effort, not as medical advice — confirm the scale and its cut-offs for your use case.

Use it

1. Download the FHIR Questionnaire JSON, or
2. open the Builder, choose + Add → From template…, search for “Pain Assessment” and insert it. It arrives as one titled group with its calculations wired, and you can keep editing it.

More templates

• Patient Demographics
• Allergies
• Current Medications

This material contains content from LOINC (loinc.org). LOINC is copyright © Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee and is available at no cost under the LOINC license.