PQI Stage I

The Quality Improvement Program is divided into a Patient section and one for Providers.

Patient Partners

Please complete the surveys. Mark the result on the final score sheet. If you feel comfortable, send the completed results to me by email or hand it in at our next meeting.

Adverse Child Events Score

Overview of Pain Impact

Wellness/State of Health Measure

Patient Tools

Patient Summary Sheets Stage I

Noticing your body and your pain is the first step.

Here are the next Steps to Healing

Provider Partners

Step 1:

Please complete the baseline Tools Used in Practice. Print button clearly displayed if you prefer to keep a reminder of tools. If you have used all the tools, completing once is enough.

At first visit, patient should complete these two forms.

Overview of Pain Impact

Wellness/State of Health Measure

Within the first few months, patients should complete this form:

Adverse Child Events Score

Use the summary form below to keep a record of the results:

Patient Summary Forms 

If fibromyalgia is suspected, I find the Widespread Pain Index the most useful diagnostic tool.

Once the Overview of Pain Impact and Wellness forms are completed, email a link to the patient: Next steps to healing. 

Feel free to contact me by email or phone or fax if you have any questions or suggestions.