Use our readymade template to create your Foot and Ankle Ability Measure (FAAM) assessment tool
Create your care assessments
| FAAM score | Severity | Proposed treatment |
|---|---|---|
| 80-100% | Minimal | May not need treatment |
| 60-79% | Mild | Physical therapy |
| 40-59% | Moderate | Consider surgery |
| 20-39% | Severe | Surgery |
| 0-19% | Very severe | Immediate initiation |
- Prebuilt template with FAAM scoring to assess the presence of foot and ankle disorders and measure their severity
- 21-item questionnaire that scores each item from “0” (Unable) to “4” (None at all)
- Real-time calculation of FAAM 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 the disorder
- 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 |
| Select the difficult level for each activity | |
| 1. Standing | None at all |
| 2. Walking on even ground | Slight |
| 3. Walking on even ground without shoes | Moderate |
| 4. Walking up hills | Extreme |
| 5. Walking down hills | Unable |
| 6. Going up stairs | None at all |
| 7. Going down stairs | Slight |
| 8. Walking on uneven ground | Moderate |
| 9. Stepping up and down curves | Extreme |
| 10. Squatting | Unable |
| 11. Coming up to your toes | None at all |
| 12. Walking initially | Slight |
| 13. Walking 5 minutes or less | Moderate |
| 14. Walking approximately 10 minutes | Extreme |
| 15. Walking 15 minutes or greater | Unable |
| 16. Home responsibilities | None at all |
| 17. Activities of daily living | Slight |
| 18. Personal care | Moderate |
| 19. Light to moderate work (standing, walking) | Extreme |
| 20. Heavy work (push/pulling, climbing, carrying) | Unable |
| 21. Recreational activities | None at all |
| FAAM Score (in %) | 60 |
- Pre-populate patient details such as patient id, name, email etc in the FAAM assessment form before sharing it with the patients
- Send an email invitation with a secure link for patients to complete their FAAM assessment form prior to their visit
- Allow patients to save their progress and complete their FAAM assessment form at a later time without losing any responses
- Set up an email template for your FAAM assessment and automatically send invitation emails to multiple patients with ease
- Send a confirmation email to the patients with their FAAM score, diagnosis, next steps when they submit their FAAM assessment
Track patient responses in Google Sheets
| A | B | C | D | E | |
|---|---|---|---|---|---|
| 1 | Name | Question | Answer | Score | Total Score |
| 2 | John W | 1. Standing | None at all | 4 | 60 |
| 3 | John W | 2. Walking on even ground | Slight | 3 | 60 |
| 4 | John W | 3. Walking on even ground without shoes | Moderate | 2 | 60 |
| 5 | John W | 4. Walking up hills | Extreme | 1 | 60 |
| 6 | John W | 5. Walking down hills | Unable | 0 | 60 |
| 7 | John W | 6. Going up stairs | None at all | 4 | 60 |
| 8 | John W | 7. Going down stairs | Slight | 3 | 60 |
| 9 | John W | 8. Walking on uneven ground | Moderate | 2 | 60 |
| 10 | John W | 9. Stepping up and down curves | Extreme | 1 | 60 |
| 11 | John W | 10. Squatting | Unable | 0 | 60 |
| 12 | John W | 11. Coming up to your toes | None at all | 4 | 60 |
| 13 | John W | 12. Walking initially | Slight | 3 | 60 |
| 14 | John W | 13. Walking 5 minutes or less | Moderate | 2 | 60 |
| 15 | John W | 14. Walking approximately 10 minutes | Extreme | 1 | 60 |
| 16 | John W | 15. Walking 15 minutes or greater | Unable | 0 | 60 |
| 17 | John W | 16. Home responsibilities | None at all | 4 | 60 |
| 18 | John W | 17. Activities of daily living | Slight | 3 | 60 |
| 19 | John W | 18. Personal care | Moderate | 2 | 60 |
| 20 | John W | 19. Light to moderate work (standing, walking) | Extreme | 1 | 60 |
| 21 | John W | 20. Heavy work (push/pulling, climbing, carrying) | Unable | 0 | 60 |
| 22 | John W | 21. Recreational activities | None at all | 4 | 60 |
- Export patient responses including the calculated FAAM score to Google Sheets for easy record-keeping
- Export individual points for 21 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 foot and ankle disorders
- Receive a copy of the response and the calculated FAAM score by email whenever a patient submits their FAAM 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 |
| Select the difficult level for each activity | |
| 1. Standing: | None at all |
| 2. Walking on even ground: | Slight |
| 3. Walking on even ground without shoes: | Moderate |
| 4. Walking up hills: | Extreme |
| 5. Walking down hills: | Unable |
| 6. Going up stairs: | None at all |
| 7. Going down stairs: | Slight |
| 8. Walking on uneven ground: | Moderate |
| 9. Stepping up and down curves: | Extreme |
| 10. Squatting: | Unable |
| 11. Coming up to your toes: | None at all |
| 12. Walking initially: | Slight |
| 13. Walking 5 minutes or less: | Moderate |
| 14. Walking approximately 10 minutes: | Extreme |
| 15. Walking 15 minutes or greater: | Unable |
| 16. Home responsibilities: | None at all |
| 17. Activities of daily living: | Slight |
| 18. Personal care: | Moderate |
| 19. Light to moderate work (standing, walking): | Extreme |
| 20. Heavy work (push/pulling, climbing, carrying): | Unable |
| 21. Recreational activities: | None at all |
| FAAM Score (in %): | 60 |
| FAAM Score (in %): | 60 |
- Create a HIPAA compliant FAAM 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 FAAM form responses to Google Sheets and sending them on email
- Prepopulate patient details in FAAM 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
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November 27, 2023
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July 10, 2023
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