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the guide for adults with hip dysplasia — Dr Sophie West and Denise Sutherland
name hip pain record sheet
Mark your daily pain level out of 10 for each day of the month. Mark the hip in the Legend above.If you have pain in both hips, use a different symbol or colour for each hip, and note this in the Legend.
pain
leve
l
month
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 1918 20 21 22 23 24 25 26 27 28 29 30 31
10
9
8
7
6
5
4
3
2
1
0
pain
leve
l
month
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 1918 20 21 22 23 24 25 26 27 28 29 30 31
10
9
8
7
6
5
4
3
2
1
0
pain
leve
l
month
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 1918 20 21 22 23 24 25 26 27 28 29 30 31
10
9
8
7
6
5
4
3
2
1
0
Left HipRight Hip
Legend
the guide for adults with hip dysplasia — Dr Sophie West and Denise Sutherland
name hip pain record sheet
Mark your daily pain level out of 10 for each day of the month. Mark the hip in the Legend above.If you have pain in both hips, use a different symbol or colour for each hip, and note this in the Legend.
pain
leve
l
month
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 1918 20 21 22 23 24 25 26 27 28 29 30 31
10
9
8
7
6
5
4
3
2
1
0
pain
leve
l
month
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 1918 20 21 22 23 24 25 26 27 28 29 30 31
10
9
8
7
6
5
4
3
2
1
0
pain
leve
l
month
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 1918 20 21 22 23 24 25 26 27 28 29 30 31
10
9
8
7
6
5
4
3
2
1
0
Left HipRight Hip
Legend
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