Use our readymade template to create your Mood Disorder Questionnaire (MDQ) for screening bipolar disorder
Create your care assessments
| MDQ score | Bipolar Disorder |
|---|---|
| 7 or more | Positive screen |
- Prebuilt template with MDQ scoring to assess the presence of bipolar disorder
- 13-item questionnaire that scores each item as “0” (No) to “1” (Yes)
- Real-time calculation of MDQ Score and bipolar disorder 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 |
| 1. Has there ever been a period of time when you were not your usual self and… | |
| 2. If you checked YES to more than one of the above, have several of these ever happened during the same period of time? | Yes |
| 3. How much of a problem did any of these cause you — like being able to work; having family, money, or legal troubles; getting into arguments or fights? | Serious problem |
| MDQ Score | 8 |
| Bipolar Disorder | Positive screen |
- Pre-populate patient details such as patient id, name, email etc in the MDQ assessment form before sharing it with the patients
- Send an email invitation with a secure link for patients to complete their MDQ assessment form prior to their visit
- Allow patients to save their progress and complete their MDQ assessment form at a later time without losing any responses
- Set up an email template for your MDQ assessment and automatically send invitation emails to multiple patients with ease
- Send a confirmation email to the patients with their MDQ score, diagnosis, next steps when they submit their MDQ assessment
Track patient responses in Google Sheets
| A | B | C | D | E | |
|---|---|---|---|---|---|
| 1 | Name | Question | Answer | Score | Total Score |
| 2 | John W | 2. If you checked YES to more than one of the above, have several of these ever happened during the same period of time? | Yes | 1 | 8 |
| 3 | John W | 3. How much of a problem did any of these cause you — like being able to work; having family, money, or legal troubles; getting into arguments or fights? | Serious problem | 1 | 8 |
- Export patient responses including the calculated MDQ score and bipolar disorder to Google Sheets for easy record-keeping
- Export individual points for 13 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 bipolar symptoms
- Receive a copy of the response and the calculated MDQ score by email whenever a patient submits their MDQ 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: | ****** |
| 2. If you checked YES to more than one of the above, have several of these ever happened during the same period of time?: | Yes |
| 3. How much of a problem did any of these cause you — like being able to work; having family, money, or legal troubles; getting into arguments or fights?: | Serious problem |
| MDQ Score: | 8 |
| Bipolar Disorder: | Positive screen |
| MDQ Score: | 8 |
| Bipolar Disorder: | Positive screen |
- Create a HIPAA compliant MDQ 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 MDQ form responses to Google Sheets and sending them on email
- Prepopulate patient details in MDQ 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 23, 2023
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February 16, 2024
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October 31, 2023
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July 12, 2023
It very friendly to used. I love it. For my case multiple signature needed. it's supporting
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November 27, 2023
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July 10, 2023
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