| RPT |
|Pain, Enjoyment, and General Activity (PEG)
| Gender: <.Patient_Gender.>
|
| PEG Average Score = <-AVERAGE->
|
|
|Questions and Answers:
|
| 1. What number best describes your pain on average in the past week?
| <*Answer_9089*>
| 2. What number best describes how, during the past week, pain has
|
| interfered with your enjoyment of life?
| <*Answer_9090*>
| 3. What number best describes how, during the past week, pain has
| interfered with your general activity?
| <*Answer_9091*>
|
|Information contained in this note is based on a self-report assessment
|and is not sufficient to use alone for diagnostic purposes. Assessment
|results should be verified for accuracy and used in conjunction with
|other diagnostic activities.
| Date Given: <.Date_Given.>
| Clinician: <.Staff_Ordered_By.>
| Location: <.Location.>
|
| Veteran: <.Patient_Name_Last_First.>
| SSN: <.Patient_SSN.>
| DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)
|
