Rheumatoid Arthritis Flare Evaluation Form
Patient Name
Date
Are you currently experiencing a flare?
Yes
No
When did the flare start?
Duration of current flare (days)
What symptoms are you experiencing?
Joints affected
Pain level (0-10)
Morning stiffness duration (minutes)
Changes in fatigue
Increased
Same
Decreased
Other symptoms
Triggers (stress, infection, missed medication, etc.)
Current medications
Treatments/actions taken for this flare
Physician notes