Mai Device Assessment
Info
Mai Device Pain Assessment
Application for gathering the data when placing the Mai Device.
DO NOT enter real Patient Name and Surname. This is a Test Application
Send the comments to: rok@maimedical.ch
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Mai Device Pain Assessment - Post-Discharge Follow-up
Post-Discharge Follow-up
*(Completed by patient after device removal)*
A. How long did you wear the device?
B. Are you still wearing the device?
Select...
Yes
No
C. When did you remove the device?
D. Did your mobility (movement) improve?
Select...
Yes
No
E. How would you rate your pain improvement?
Select...
Significant Improvement
Moderate Improvement
Slight Improvement
No Improvement
Got Worse
F. How would you rate your mood improvement?
Select...
Significant Improvement
Moderate Improvement
Slight Improvement
No Improvement
Got Worse
G. Have you changed your medication usage since using the device?
H. Additional comments or observations:
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Submit Follow-up