Assessment Tools

Assessment tools let you keep a record of your symptoms. Having this record with you can help when you are talking to your doctor about how to manage your symptoms.  You can print out these forms and fill them out, then take them to your doctor’s appointments.

Brief Pain Inventory Short Form (PDF) 
Copyright 1991 Charles S. Cleeland, Ph.D. -- Pain Research Group -- Used by permission.

Brief Pain Inventory Long Form (PDF) 
Copyright 1991 Charles S. Cleeland, Ph.D. -- Pain Research Group -- Used by permission.

Brief Fatigue Inventory (PDF) 
Copyright 1991 Charles S. Cleeland, Ph.D. -- Pain Research Group -- Used by permission.

Symptom Assessment Inventory (PDF)
Copyright 1999 -- The University of Texas M.D. Anderson Cancer Center -- Used by permission.

Modified Edmonton Symptom Assessment Scale (PDF)

Memorial Symptom Assessment Scale (PDF)

Communication Instrument (PDF)

Additional Assessment Tools

There a number of other good assessment tools available on the Internet. A few examples can be found on the following sites: 

Hospice Palliative Care Project: Record of Care

The Hospice Palliative Care (HPCNET) Project is a joint effort of the Temmy Latner Centre for Palliative Care and the Toronto Community Care Access Centre, working with many community Hospice programs and the Ontario Ministry of Health and Long-Term Care. The HPCNET Web site is dedicated to home palliative care coordination and service delivery.

• Mouth Care Assessment Tool and Flow Sheet (PDF)
• Nausea and Vomiting Flow Sheet (PDF)
• Initial Assessment Tool for Nausea and Vomiting (PDF)
• Initial Respiratory Symptom Assessment (PDF)

Promoting Excellence in End of Life Care

Promoting Excellence in End-of-Life Care is dedicated to long-term changes to improve health care for dying people and their families. The tools on this page were developed or adapted by Promoting Excellence in End-of-Life Care grantees and national workgroups. This resource is a work in progress and will be updated with many more tools in the near future.

Stop Pain: Forms for Caregiving

Stop Pain is the Web site for the Department of Pain Medicine and Palliative Care, at the Beth Israel Medical Center.  The Department of Pain Medicine and Palliative Care is dedicated to providing highest quality care in pain management and palliative care, and advancing the educational and research aims of these disciplines.

• List of Patient Needs (PDF)

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This page was last updated: December 14th, 2004 at 12:14pm.