Your Guide to Injury and Illness Recovery

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Living Abled Forms

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Goals

Define our goals for your body, mind and spirit, and when we are going to achieve these goals.

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Patient History

Complete this comprehensive history form prior to seeing a health care provider for the first time or for a significant problem. This will help health care providers in understanding our problems and our medical history.

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Pain Drawing

Complete this so others know where your pain is located and what it feels like.

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Activities of Daily Living – Checklist

Complete this one-page checklist of basic and instrumental activities of daily living to convey concisely how we are doing. Provide this at our first visit to those involved in our care and, if there is a change in our status, at subsequent visits.

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Activities of Daily Living – Questions

Complete these 25 questions to convey the challenges we face and how they impact our daily life. Provide this during our first visit with care providers and others we are seeing.

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Daily Summary

Complete this daily to reflect upon what occurred during the day. This includes: summary of day; pain, functional and stress levels; journal entry; positives for the day; health checklist; gratitude; and plans for tomorrow.

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Doctor Selection

Use this checklist to help determine the most appropriate health care provider.

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Patient-Doctor Agreement

Use this agreement to clearly define the relationship we want with our doctors — it defines our mutual responsibilities.

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Doctor Visit – Checklists

Use this checklist to prepare for a doctor visit, and during the visit, to achieve better outcomes.

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Doctor Visit

Complete this form prior to every doctor visit, and during each visit, to ensure our questions are answered and we achieve the best benefit from that visit.

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Relationship Agreement

Use this agreement to define the relationship we want with anyone involved in our care, including health care professionals, case managers, family, claims professionals, attorneys and employers.

Also see our list of recommended reading:

• Health reference books, list with links to Amazon

book link: Living Abled and Healthy

Your Guide to Injury and Illness Recovery

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