Use our readymade template to create your Upper Extremity Functional Index (UEFI) assessment tool
Create your care assessments
| UEFI score | Proposed treatment |
|---|---|
| 0-20 | Severe difficulty or unable to perform activities |
| 21-40 | Moderate to quite a bit of difficulty |
| 41-60 | Little to moderate difficulty |
| 61-80 | Little difficulty |
| 81-100 | No difficulty |
- Prebuilt template with UEFI scoring to assess the level of difficulty an individual has with their upper limb
- 20-item questionnaire that scores each item from “0” (unable to perform activity) to “4” (no difficulty)
- Real-time calculation of UEFI 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 patient's upper limb functionality
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. Any of your usual work, housework, or school activities | No difficulty |
| 2. Your usual hobbies, recreational or sporting activities | A little bit of difficulty |
| 3. Lifting a bag of groceries to waist level | Moderate difficulty |
| 4. Lifting a bag of groceries above your head | Quite a bit of difficulty |
| 5. Grooming your hair | Extreme difficulty or unable to perform activity |
| 6. Pushing up on your hands (eg from bathtub or chair) | No difficulty |
| 7. Preparing food (eg. peeling, cutting) | A little bit of difficulty |
| 8. Driving | Moderate difficulty |
| 9. Vacuuming, sweeping or raking | Quite a bit of difficulty |
| 10. Dressing | Extreme difficulty or unable to perform activity |
| 11. Doing up buttons | No difficulty |
| 12. Using tools or appliances | A little bit of difficulty |
| 13. Opening doors | Moderate difficulty |
| 14. Cleaning | Quite a bit of difficulty |
| 15. Tying or lacing shoes | Extreme difficulty or unable to perform activity |
| 16. Sleeping | No difficulty |
| 17. Laundering clothes (eg. washing, ironing, folding) | A little bit of difficulty |
| 18. Opening a jar | Moderate difficulty |
| 19. Throwing a ball | Quite a bit of difficulty |
| 20. Carrying a small suitcase with your affected limb | Extreme difficulty or unable to perform activity |
| UEFI score | 45 |
- Allow patients to fill in their details such as patient id, name, email etc in the UEFI assessment form
- Send an email invitation with a secure link for patients to complete their UEFI assessment form prior to their visit
- Allow patients to save their progress and complete their UEFI assessment form at a later time without losing any responses
- Set up an email template for your UEFI assessment and automatically send invitation emails to multiple patients with ease
- Send a confirmation email to the patients with their UEFI score, diagnosis, next steps when they submit their UEFI assessment
Track patient responses in Google Sheets
| A | B | C | D | E | |
|---|---|---|---|---|---|
| 1 | Name | Question | Answer | Score | Total Score |
| 2 | John W | 1. Any of your usual work, housework, or school activities | No difficulty | 4 | 45 |
| 3 | John W | 2. Your usual hobbies, recreational or sporting activities | A little bit of difficulty | 3 | 45 |
| 4 | John W | 3. Lifting a bag of groceries to waist level | Moderate difficulty | 2 | 45 |
| 5 | John W | 4. Lifting a bag of groceries above your head | Quite a bit of difficulty | 1 | 45 |
| 6 | John W | 5. Grooming your hair | Extreme difficulty or unable to perform activity | 0 | 45 |
| 7 | John W | 6. Pushing up on your hands (eg from bathtub or chair) | No difficulty | 4 | 45 |
| 8 | John W | 7. Preparing food (eg. peeling, cutting) | A little bit of difficulty | 3 | 45 |
| 9 | John W | 8. Driving | Moderate difficulty | 2 | 45 |
| 10 | John W | 9. Vacuuming, sweeping or raking | Quite a bit of difficulty | 1 | 45 |
| 11 | John W | 10. Dressing | Extreme difficulty or unable to perform activity | 0 | 45 |
| 12 | John W | 11. Doing up buttons | No difficulty | 4 | 45 |
| 13 | John W | 12. Using tools or appliances | A little bit of difficulty | 3 | 45 |
| 14 | John W | 13. Opening doors | Moderate difficulty | 2 | 45 |
| 15 | John W | 14. Cleaning | Quite a bit of difficulty | 1 | 45 |
| 16 | John W | 15. Tying or lacing shoes | Extreme difficulty or unable to perform activity | 0 | 45 |
| 17 | John W | 16. Sleeping | No difficulty | 4 | 45 |
| 18 | John W | 17. Laundering clothes (eg. washing, ironing, folding) | A little bit of difficulty | 3 | 45 |
| 19 | John W | 18. Opening a jar | Moderate difficulty | 2 | 45 |
| 20 | John W | 19. Throwing a ball | Quite a bit of difficulty | 1 | 45 |
| 21 | John W | 20. Carrying a small suitcase with your affected limb | Extreme difficulty or unable to perform activity | 0 | 45 |
- Export patient responses including the calculated UEFI 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 functionality
- Receive a copy of the response and the calculated UEFI score by email whenever a patient submits their UEFI 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. Any of your usual work, housework, or school activities: | No difficulty |
| 2. Your usual hobbies, recreational or sporting activities: | A little bit of difficulty |
| 3. Lifting a bag of groceries to waist level: | Moderate difficulty |
| 4. Lifting a bag of groceries above your head: | Quite a bit of difficulty |
| 5. Grooming your hair: | Extreme difficulty or unable to perform activity |
| 6. Pushing up on your hands (eg from bathtub or chair): | No difficulty |
| 7. Preparing food (eg. peeling, cutting): | A little bit of difficulty |
| 8. Driving: | Moderate difficulty |
| 9. Vacuuming, sweeping or raking: | Quite a bit of difficulty |
| 10. Dressing: | Extreme difficulty or unable to perform activity |
| 11. Doing up buttons: | No difficulty |
| 12. Using tools or appliances: | A little bit of difficulty |
| 13. Opening doors: | Moderate difficulty |
| 14. Cleaning: | Quite a bit of difficulty |
| 15. Tying or lacing shoes: | Extreme difficulty or unable to perform activity |
| 16. Sleeping: | No difficulty |
| 17. Laundering clothes (eg. washing, ironing, folding): | A little bit of difficulty |
| 18. Opening a jar: | Moderate difficulty |
| 19. Throwing a ball: | Quite a bit of difficulty |
| 20. Carrying a small suitcase with your affected limb: | Extreme difficulty or unable to perform activity |
| UEFI score: | 45 |
| UEFI score: | 45 |
- Create a HIPAA compliant UEFI 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 UEFI form responses to Google Sheets and sending them on email
- Prepopulate patient details in UEFI 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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