Alkem

Patient No *

Patient Initials *

Age (in Years) *

Sex *

Male Female

Clinical History *

Type of surgery or traumatic injury
Baseline pain intensity scores

NSAID Prescribed *

Diclofenac Aceclofenac

Brand Name *

Dosage *

Route of Administration *

Frequency of Administration *

Duration of Treatment *

Baseline *

1-hour post-medication *

2 hours post-medication *

4 hours post-medication *

Duration of Analgesic Effect *

Adverse Events *

Event

Severity

Management

Patient Satisfaction *

Very satisfied Satisfied Neutral Dissatisfied Very dissatisfied

Preference for *

diclofenac aceclofenac

Patient Identification