Complete the following form, providing patient demographics, pertinent clinical information and any additional information you consider relevant.
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Transfer / Initiate Care as PTP
Delayed Recovery Evaluation
Cognitive Behavioral Evaluation
Pain management consultation for further recomondations
Injections / Other
Evaluate Patient For:
Additional symptom and areas of intervention inherit to chronic pain/ functional disability that appear applicable
Excessive medication usage / requests
Increased pain complaints / behavior
Need for medication tampering / detox
Failure to respond to treatment
Frustration with medical care
Sadness / Depression / Hopelessness
Anxiety / Panic / PTSD