Use our readymade template to create your Neck Disability Index (NDI) assessment tool
Create your care assessments
| NDI score | Disability Level | Proposed treatment |
|---|---|---|
| 0-4 | No disability | May not need treatment |
| 5-14 | Mild disability | Physical therapy |
| 15-24 | Moderate disability | Consider medication and physical therapy |
| 25-34 | Severe disability | Consider medication, physical therapy, and possible surgery |
| 35-50 | Complete disability | Immediate medical attention |
- Prebuilt template with NDI scoring to assess the presence and level of neck disability
- 10-item questionnaire that scores each item from “0” (no disability) to “5” (complete disability)
- Real-time calculation of NDI Score and disability level 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 neck disability
- 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. Pain intensity | The pain is severe but comes and goes. |
| 2. Personal care | I need some help, but manage most of my personal care. |
| 3. Lifting | Pain prevents me from lifting heavy objects, but I can manage light to medium weights if they are conveniently positioned. |
| 4. Reading | I cannot read as much as I want because of moderate pain in my neck. |
| 5. Headaches | I have severe headaches which come frequently. |
| 6. Concentration | I have a lot of difficulty concentrating when I want to. |
| 7. Work | I can hardly do any work at all. |
| 8. Driving | I can hardly drive my car at all because of severe pain in my neck. |
| 9. Sleeping | My sleep is greatly disturbed (3-5 hours sleepless). |
| 10. Recreation | I can hardly do any recreational activities because of pain in my neck. |
| NDI Score | 40 |
| Disability Level | Complete disability |
- Pre-populate patient details such as patient id, name, email etc in the NDI assessment form before sharing it with the patients
- Send an email invitation with a secure link for patients to complete their NDI assessment form prior to their visit
- Allow patients to save their progress and complete their NDI assessment form at a later time without losing any responses
- Set up an email template for your NDI assessment and automatically send invitation emails to multiple patients with ease
- Send a confirmation email to the patients with their NDI score, diagnosis, next steps when they submit their NDI assessment
Track patient responses in Google Sheets
| A | B | C | D | E | |
|---|---|---|---|---|---|
| 1 | Name | Question | Answer | Score | Total Score |
| 2 | John W | 1. Pain intensity | The pain is severe but comes and goes. | 4 | 40 |
| 3 | John W | 2. Personal care | I need some help, but manage most of my personal care. | 3 | 40 |
| 4 | John W | 3. Lifting | Pain prevents me from lifting heavy objects, but I can manage light to medium weights if they are conveniently positioned. | 3 | 40 |
| 5 | John W | 4. Reading | I cannot read as much as I want because of moderate pain in my neck. | 3 | 40 |
| 6 | John W | 5. Headaches | I have severe headaches which come frequently. | 4 | 40 |
| 7 | John W | 6. Concentration | I have a lot of difficulty concentrating when I want to. | 3 | 40 |
| 8 | John W | 7. Work | I can hardly do any work at all. | 4 | 40 |
| 9 | John W | 8. Driving | I can hardly drive my car at all because of severe pain in my neck. | 4 | 40 |
| 10 | John W | 9. Sleeping | My sleep is greatly disturbed (3-5 hours sleepless). | 4 | 40 |
| 11 | John W | 10. Recreation | I can hardly do any recreational activities because of pain in my neck. | 4 | 40 |
- Export patient responses including the calculated NDI score and disability level to Google Sheets for easy record-keeping
- Export individual points for 10 items 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 neck disability
- Receive a copy of the response and the calculated NDI score by email whenever a patient submits their NDI 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. Pain intensity: | The pain is severe but comes and goes. |
| 2. Personal care: | I need some help, but manage most of my personal care. |
| 3. Lifting: | Pain prevents me from lifting heavy objects, but I can manage light to medium weights if they are conveniently positioned. |
| 4. Reading: | I cannot read as much as I want because of moderate pain in my neck. |
| 5. Headaches: | I have severe headaches which come frequently. |
| 6. Concentration: | I have a lot of difficulty concentrating when I want to. |
| 7. Work: | I can hardly do any work at all. |
| 8. Driving: | I can hardly drive my car at all because of severe pain in my neck. |
| 9. Sleeping: | My sleep is greatly disturbed (3-5 hours sleepless). |
| 10. Recreation: | I can hardly do any recreational activities because of pain in my neck. |
| NDI Score: | 40 |
| Disability Level: | Complete disability |
| NDI Score: | 40 |
| Disability Level: | Complete disability |
- Create a HIPAA compliant NDI 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 NDI form responses to Google Sheets and sending them on email
- Prepopulate patient details in NDI 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
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