Month:______________________________

Pads Tampons Clots Flooding Score

Date Light Medium Heavy Light Medium Heavy 5cent 50cent 1pteach
size size episode

(1pt (5pts
(1pteach) (5ptseach) (20ptseach) (1pt (5pts (10pts each) each)
each) each) each)

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Total

Eachrowrepresentsadayofthemonth

Countthenumberofsanitarypadsand/ortamponsyouuseeachday(24hour
period).

Calculateascoreforeachday,thenaddupthescoreattheendofthemonth.

BleedingbetweenperiodsIfyoualsoexperiencedbleedingbetweenperiodsthat
requiredsanitaryprotectionpleaserecordthisontherelevantdays.

Clotsifyoupassclots,pleaseindicatethisontherelevantdaysandthe
approximatesize(ie.closertoanAustralian5centor50centpiece).

Floodingifyouexperienceanyepisodesofflooding/overflowing/stainingof
clothing/underwearpleaseindicatethenumberofepisodesontherelevantdays.

Doubleprotectionifyouhaveusedbothapadandtamponsimultaneouslyand
bothsanitaryitemswerestainedwithblooddontforgettoincludebothsanitary
itemsonthePBAC.

PBACScoringSystem

Pads

1point Foreachlightlystainedpad


5points Foreachmoderatelystainedpad

20points Foreachcompletelysaturatedpad

Tampons

1point Foreachlightlystainedtampon


5points Foreachmoderatelystainedtampon


10points Foreachcompletelysaturatedtampon

Clots/Flooding
1point Foreachsmallclot(Australian5centcoin)
5points Foreachlargeclot(Australian50centcoin)
5points Foreachepisodeofflooding

 Month:January2009
Pads Tampons Clots Flooding Score

Date Light Medium Heavy Light Medium Heavy 5cent 50cent 5pts
size size each
episode
(1pt (5pts
(1pteach) (5ptseach) (20ptseach) (1pt (5pts (10pts each) each)
each) each) each)

1
2
3
4
5
6 || || | | | 70
7 ||| || 55
8 ||||| 25
9 || || 12
10 || 2
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Total 164