Use our readymade template to create your Disabilities of the Arm, Shoulder and Hand (DASH) assessment tool
Create your care assessments
DASH score | Severity | Proposed treatment |
---|---|---|
0-20 | Mild | Conservative management |
21-40 | Moderate | Physical therapy |
41-60 | Severe | Surgical intervention |
61-80 | Very severe | Surgical intervention |
81-100 | Extremely severe | Surgical intervention |
- Prebuilt template with DASH scoring to assess the presence of upper limb disorders and measure its severity
- 30-item questionnaire that scores each item based on the patient's ability to perform certain activities and the severity of symptoms
- Real-time calculation of DASH Score based on the form responses
- Collect patient data and other sensitive healthcare data using our HIPAA compliant online assessment forms
- Compare the scores from the initial screening with that of the followup to track the progression of upper limb disorders
- Easily create responsive forms that allow patients to complete their assessments on any device at any time
Collect responses from your patients
Patient ID | 1004 |
Patient Name | John W |
Patient Email | johnw@ymail.com |
Patient Phone Number | 0987654321 |
Doctor's Name | Dr. Smith |
Location | New York |
1. Open a tight or new jar. | Mild difficulty |
2. Write. | No difficulty |
3. Turn a key. | Moderate difficulty |
4. Prepare a meal. | Severe difficulty |
5. Push open a heavy door. | Unable |
6. Place an object on a shelf above your head. | No difficulty |
7. Do heavy household chores (e.g., wash walls, wash floors). | Mild difficulty |
8. Garden or do yard work. | Moderate difficulty |
9. Make a bed. | Severe difficulty |
10. Carry a shopping bag or briefcase. | Unable |
11. Carry a heavy object (over 10 lbs). | No difficulty |
12. Change a lightbulb overhead. | Mild difficulty |
13. Wash or blow dry your hair. | Moderate difficulty |
14. Wash your back. | Severe difficulty |
15. Put on a pullover sweater. | Unable |
16. Use a knife to cut food. | No difficulty |
17. Recreational activities which require little effort (e.g., card playing, knitting, etc.). | Mild difficulty |
18. Recreational activities in which you take some force or impact through your arm, shoulder or hand (e.g., golf, hammering, tennis, etc.). | Moderate difficulty |
19. Recreational activities in which you move your arm freely (e.g., playing frisbee, badminton, etc.). | Severe difficulty |
20. Manage transportation needs (getting from one place to another). | Unable |
21. Sexual activities. | No difficulty |
22. During the past week, to what extent has your arm, shoulder or hand problem interfered with your normal social activities with family, friends, neighbours or groups? | Slightly |
23. During the past week, were you limited in your work or other regular daily activities as a result of your arm, shoulder or hand problem? | Moderately limited |
24. Arm, shoulder or hand pain. | Severe |
25. Arm, shoulder or hand pain when you performed any specific activity. | Extreme |
26. Tingling (pins and needles) in your arm, shoulder or hand. | None |
27. Weakness in your arm, shoulder or hand. | Mild |
28. Stiffness in your arm, shoulder or hand. | Moderate |
29. During the past week, how much difficulty have you had sleeping because of the pain in your arm, shoulder or hand? | Severe difficulty |
30. I feel less capable, less confident or less useful because of my arm, shoulder or hand problem. | Agree |
DASH score | 45 |
- Pre-populate patient details such as patient id, name, email etc in the DASH assessment form before sharing it with the patients
- Send an email invitation with a secure link for patients to complete their DASH assessment form prior to their visit
- Allow patients to save their progress and complete their DASH assessment form at a later time without losing any responses
- Set up an email template for your DASH assessment and automatically send invitation emails to multiple patients with ease
- Send a confirmation email to the patients with their DASH score, diagnosis, next steps when they submit their DASH assessment
Track patient responses in Google Sheets
A | B | C | D | E | |
---|---|---|---|---|---|
1 | Name | Question | Answer | Score | Total Score |
2 | John W | 1. Open a tight or new jar. | Mild difficulty | 2 | 45 |
3 | John W | 2. Write. | No difficulty | 1 | 45 |
4 | John W | 3. Turn a key. | Moderate difficulty | 3 | 45 |
5 | John W | 4. Prepare a meal. | Severe difficulty | 4 | 45 |
6 | John W | 5. Push open a heavy door. | Unable | 5 | 45 |
7 | John W | 6. Place an object on a shelf above your head. | No difficulty | 1 | 45 |
8 | John W | 7. Do heavy household chores (e.g., wash walls, wash floors). | Mild difficulty | 2 | 45 |
9 | John W | 8. Garden or do yard work. | Moderate difficulty | 3 | 45 |
10 | John W | 9. Make a bed. | Severe difficulty | 4 | 45 |
11 | John W | 10. Carry a shopping bag or briefcase. | Unable | 5 | 45 |
12 | John W | 11. Carry a heavy object (over 10 lbs). | No difficulty | 1 | 45 |
13 | John W | 12. Change a lightbulb overhead. | Mild difficulty | 2 | 45 |
14 | John W | 13. Wash or blow dry your hair. | Moderate difficulty | 3 | 45 |
15 | John W | 14. Wash your back. | Severe difficulty | 4 | 45 |
16 | John W | 15. Put on a pullover sweater. | Unable | 5 | 45 |
17 | John W | 16. Use a knife to cut food. | No difficulty | 1 | 45 |
18 | John W | 17. Recreational activities which require little effort (e.g., card playing, knitting, etc.). | Mild difficulty | 2 | 45 |
19 | John W | 18. Recreational activities in which you take some force or impact through your arm, shoulder or hand (e.g., golf, hammering, tennis, etc.). | Moderate difficulty | 3 | 45 |
20 | John W | 19. Recreational activities in which you move your arm freely (e.g., playing frisbee, badminton, etc.). | Severe difficulty | 4 | 45 |
21 | John W | 20. Manage transportation needs (getting from one place to another). | Unable | 5 | 45 |
22 | John W | 21. Sexual activities. | No difficulty | 1 | 45 |
23 | John W | 22. During the past week, to what extent has your arm, shoulder or hand problem interfered with your normal social activities with family, friends, neighbours or groups? | Slightly | 2 | 45 |
24 | John W | 23. During the past week, were you limited in your work or other regular daily activities as a result of your arm, shoulder or hand problem? | Moderately limited | 3 | 45 |
25 | John W | 24. Arm, shoulder or hand pain. | Severe | 4 | 45 |
26 | John W | 25. Arm, shoulder or hand pain when you performed any specific activity. | Extreme | 5 | 45 |
27 | John W | 26. Tingling (pins and needles) in your arm, shoulder or hand. | None | 1 | 45 |
28 | John W | 27. Weakness in your arm, shoulder or hand. | Mild | 2 | 45 |
29 | John W | 28. Stiffness in your arm, shoulder or hand. | Moderate | 3 | 45 |
30 | John W | 29. During the past week, how much difficulty have you had sleeping because of the pain in your arm, shoulder or hand? | Severe difficulty | 4 | 45 |
31 | John W | 30. I feel less capable, less confident or less useful because of my arm, shoulder or hand problem. | Agree | 4 | 45 |
- Export patient responses including the calculated DASH score to Google Sheets for easy record-keeping
- Export individual points for each item to Google Sheets for data manipulation and analysis for comprehensive insights
- Use pre-built reports to easily keep track of patient progress over time and monitor changes in their upper limb function
- Receive a copy of the response and the calculated DASH score by email whenever a patient submits their DASH assessment
- Use data in Google Sheets to integrate with external EHR systems for seamless data transfer
HIPAA compliance
Patient ID: | 1004 |
Patient Name: | ****** |
Patient Email: | ****** |
Patient Phone Number: | ****** |
Doctor's Name: | Dr. Smith |
Location: | New York |
1. Open a tight or new jar.: | Mild difficulty |
2. Write.: | No difficulty |
3. Turn a key.: | Moderate difficulty |
4. Prepare a meal.: | Severe difficulty |
5. Push open a heavy door.: | Unable |
6. Place an object on a shelf above your head.: | No difficulty |
7. Do heavy household chores (e.g., wash walls, wash floors).: | Mild difficulty |
8. Garden or do yard work.: | Moderate difficulty |
9. Make a bed.: | Severe difficulty |
10. Carry a shopping bag or briefcase.: | Unable |
11. Carry a heavy object (over 10 lbs).: | No difficulty |
12. Change a lightbulb overhead.: | Mild difficulty |
13. Wash or blow dry your hair.: | Moderate difficulty |
14. Wash your back.: | Severe difficulty |
15. Put on a pullover sweater.: | Unable |
16. Use a knife to cut food.: | No difficulty |
17. Recreational activities which require little effort (e.g., card playing, knitting, etc.).: | Mild difficulty |
18. Recreational activities in which you take some force or impact through your arm, shoulder or hand (e.g., golf, hammering, tennis, etc.).: | Moderate difficulty |
19. Recreational activities in which you move your arm freely (e.g., playing frisbee, badminton, etc.).: | Severe difficulty |
20. Manage transportation needs (getting from one place to another).: | Unable |
21. Sexual activities.: | No difficulty |
22. During the past week, to what extent has your arm, shoulder or hand problem interfered with your normal social activities with family, friends, neighbours or groups?: | Slightly |
23. During the past week, were you limited in your work or other regular daily activities as a result of your arm, shoulder or hand problem?: | Moderately limited |
24. Arm, shoulder or hand pain.: | Severe |
25. Arm, shoulder or hand pain when you performed any specific activity.: | Extreme |
26. Tingling (pins and needles) in your arm, shoulder or hand.: | None |
27. Weakness in your arm, shoulder or hand.: | Mild |
28. Stiffness in your arm, shoulder or hand.: | Moderate |
29. During the past week, how much difficulty have you had sleeping because of the pain in your arm, shoulder or hand?: | Severe difficulty |
30. I feel less capable, less confident or less useful because of my arm, shoulder or hand problem. : | Agree |
DASH score: | 45 |
DASH score: | 45 |
- Create a HIPAA compliant DASH assessment form to safely collect, store and access patient responses
- Mark fields as Protected Health Information (PHI) to secure sensitive patient data and limit access to PHI
- Automatically mask PHI fields when exporting DASH form responses to Google Sheets and sending them on email
- Prepopulate patient details in DASH assessments by creating secure prefill links without exposing PHI
- Limit access to patient data only for authorized personnel and minimize the risk of data breaches
These reviews are reproduced without modification from Google Workspace Marketplace.
July 27, 2023
I am 100% a fan of this company. We use HIPAA compliant Google Forms and needed a way to collect signatures, the industry standard company is TOO expensive. I started using FormEsign and it worked perfectly. It lacked the ability to provide a pdf copy of the form after signature. This company worked with me help their product evolve into something that could benefit all future clients AND the end user. The team was polite, professional, kind, enthusiastic, and willing to make a change. This earned my loyalty. I will sing their praises. Good work, and thank you!
— Royal Bush
July 23, 2023
I am not tech savvy. I chose formesign to help create registration links for clients. Vipid has been great in assisting me. He goes above and beyond. My company now has moved from the stone age to modern age through the ability to use this feature. Of the many features I am impressed with, the ability to update a form without needing to regenerate a link is amazing. I often make mistakes and that ability allows me to fix mistakes without needing to change everything. Thank you!!!
— Sol Evans
October 31, 2023
We needed a way to create forms with e-signatures and this app made it very easy. Support is also very quick and always helpful. Cannot recommend enough!
— Chris Henesy
February 16, 2024
Does not work
— Myles Sicuro
July 12, 2023
It very friendly to used. I love it. For my case multiple signature needed. it's supporting
— Senthil Kumar
November 27, 2023
Yeah this is good for all
— luqman Khan
July 10, 2023
We were looking for a way to have a signature option in our form. Formesign addon allowed us to collect signatures for the acknowledgment and consent forms. It was simple and easy to setup. Very useful addon for google forms.
— Joan S