Withdrawal Assessment

this tool is not appropriate if the participant is cognitively impaired, delirious or displaying a decreased level of consciousness. Get help ASAP!

Have you any itching, pins and needles sensations, any burning, any numbness, or do you feel bugs crawling on or under your skin?(Required)
Are you more aware of sounds around you? Are they harsh? Do they frighten you? Are you hearing anything that is disturbing to you? Are you hearing things you know are not there?(Required)
Observe for agitation(Required)
Does your head feel different? Does it feel like there is a band around your head?(Required)
Do not rate for dizziness or light-headedness. Otherwise, rate severity
Name of participant(Required)