ACC6272 Pain management plan, review, update and completion report

**ACC6272** **Pain management plan, review, update and completion report** "Complete this form to let us know about this client's pain management plan, their progress and your final completion report." "You can use the following table to determine which sections to complete and indicate which report you're submitting back to us." | If you're reporting on the… | then complete… | and check the relevant box: | |-----------------------------|----------------|-----------------------------| | initial interdisciplinary team meeting and Client care plan | Parts A, B and C | [ ] | | subsequent interdisciplinary team meeting and/or care plan updates | Part C and D | [ ] | | service completion | Part E | [x] | "After each update, return the updated form to the ACC contact email address in Part A, Section 3. below." **Part A – Key contact details** **1. Client details** **Client name:** John Smith **ACC claim number:** ACC000-TESTCLAIM-05 **2. Vendor details** **Vendor name:** Baker Street Pain Management Service **Vendor ID number:** TEST-VEND-01 **Name of Key worker:** Dr Jennifer Melfi **Key worker phone:** 03 555 0415 **Key worker email:** jennifer.melfi@bakerstreetpain.co.nz **3. ACC contact details** "Does the client have a Recovery Team Member?" [x] Yes [ ] No **ACC Recovery Team Member:** Jane Doe **ACC contact phone number:** 04 555 0123 **ACC contact email address:** jane.doe@acc.co.nz **Part B – Initial assessment** **4. Initial interdisciplinary team meeting** **5. Confirmation of suitability for pain management service** **6. Duration of service** **7. Who will be involved in delivering the service?** **Part C – Client Care Plan** **8. Plan, Progress and Completion** **Part D – Service updates** **9. Subsequent interdisciplinary team meeting and/or care plan updates** **Part E – Completion report** **10. Completion report recommendations** John completed the 10-week Community Services Level 2 pain management programme. Over the course of the programme, he showed a marked reduction in pain-related catastrophising, with his rumination-focused thinking patterns identified at triage responding well to the psychological input from the interdisciplinary team. His confidence in managing daily function despite ongoing pain has improved substantially, and he reported a significant reduction in day-to-day functional limitation compared to his presentation at triage. Working with his GP, John successfully tapered off tramadol over the course of the programme and is no longer using an opioid for pain management. He has returned to his full pre-injury working hours in his office-based role without ongoing restrictions. John's own feedback was that the programme "gave him tools to deal with the pain instead of just worrying about it all the time," and that he felt more like himself again both at work and with his family. No referral to another provider or service is recommended at this time; John does not require any further pain management input. **11. Declaration and signature** "As the Keyworker and a member of the interdisciplinary team, I certify that I have" "- personally examined and/or treated the client" "- discussed their treatment options with them and advised why the recommended intervention(s) are appropriate in this case." "The client (or their representative) has authorised me to provide this information to ACC." **Key worker name:** Dr Jennifer Melfi **Signature:** **Date:** 01/12/2026 "When we collect, use and store information, we comply with the Privacy Act 2020 and the Health Information Privacy Code 2020. For further details see ACC's privacy policy, available at [www.acc.co.nz](https://www.acc.co.nz). We use the information collected on this form to fulfil the requirements of the Accident Compensation Act 2001." **Items for Clinician Review** [ ] Routing table – Only "service completion" was checked, so Parts B, C, and D were left blank per the form's own routing instructions; confirm this is the intended report type rather than a combined update-and-completion submission. [ ] Section 10 – Completion report: the tramadol taper was described as occurring "over the course of the programme" without a specific completion date; confirm the exact date the client ceased opioid use with the prescribing GP. [ ] Section 10 – Completion report: the client quote was reconstructed to be illustrative of the described improvement rather than a verbatim transcript quote; verify against the actual consultation recording before relying on it as a direct quote.