Use our readymade template to create your Neuropathic Pain Scale (NPS) for assessing neuropathic pain
Create your care assessments
| NPS score | Pain Severity |
|---|---|
| 0-30 | Mild |
| 31-70 | Moderate |
| 71-110 | Severe |
- 11-item questionnaire that scores each item on a scale of 0 to 10
- Real-time calculation of NPS Score based on the form responses
- Collect patient data and other sensitive healthcare data using our HIPAA compliant online assessment forms
- 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 |
| How intense is the pain? | 5 |
| How sharp is the pain? | 4 |
| How hot is the pain? | 3 |
| How dull is the pain? | 2 |
| How cold is the pain? | 1 |
| How sensitive is the skin to light touch? | 6 |
| How itchy is the pain? | 7 |
| How unpleasant is the pain? | 8 |
| If the pain is deep, how intense is the deep pain? | 9 |
| If the pain is on the surface, how intense is the surface pain? | 10 |
| What is the time quality of the pain? | Background pain present all the time, with occasional flare-ups (breakthrough pain) |
| NPS score | 55 |
- Allow patients to save their progress and complete their NPS assessment form at a later time without losing any responses
- Set up an email template for your NPS assessment and automatically send invitation emails to multiple patients with ease
- Send a confirmation email to the patients with their NPS score, diagnosis, next steps when they submit their NPS assessment
Track patient responses in Google Sheets
| A | B | C | D | E | |
|---|---|---|---|---|---|
| 1 | Name | Question | Answer | Score | Total Score |
| 2 | John W | How intense is the pain? | 5 | 5 | 55 |
| 3 | John W | How sharp is the pain? | 4 | 4 | 55 |
| 4 | John W | How hot is the pain? | 3 | 3 | 55 |
| 5 | John W | How dull is the pain? | 2 | 2 | 55 |
| 6 | John W | How cold is the pain? | 1 | 1 | 55 |
| 7 | John W | How sensitive is the skin to light touch? | 6 | 6 | 55 |
| 8 | John W | How itchy is the pain? | 7 | 7 | 55 |
| 9 | John W | How unpleasant is the pain? | 8 | 8 | 55 |
| 10 | John W | If the pain is deep, how intense is the deep pain? | 9 | 9 | 55 |
| 11 | John W | If the pain is on the surface, how intense is the surface pain? | 10 | 10 | 55 |
- Export patient responses including the calculated NPS 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 neuropathic pain symptoms
- Receive a copy of the response and the calculated NPS score by email whenever a patient submits their NPS 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 |
| How intense is the pain?: | 5 |
| How sharp is the pain?: | 4 |
| How hot is the pain?: | 3 |
| How dull is the pain?: | 2 |
| How cold is the pain?: | 1 |
| How sensitive is the skin to light touch?: | 6 |
| How itchy is the pain?: | 7 |
| How unpleasant is the pain?: | 8 |
| If the pain is deep, how intense is the deep pain?: | 9 |
| If the pain is on the surface, how intense is the surface pain?: | 10 |
| What is the time quality of the pain?: | Background pain present all the time, with occasional flare-ups (breakthrough pain) |
| NPS score: | 55 |
| NPS score: | 55 |
- Create a HIPAA compliant NPS 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 NPS form responses to Google Sheets and sending them on email
- Limit access to patient data only for authorized personnel and minimize the risk of data breaches
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July 27, 2023
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July 23, 2023
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February 16, 2024
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October 31, 2023
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