Use our readymade template to create your Epworth Sleepiness Scale (ESS) screening tool for assessing daytime sleepiness
Create your care assessments
| ESS score | Sleepiness Level | Proposed treatment |
|---|---|---|
| 0-5 | Lower Normal Daytime Sleepiness | Normal lifestyle |
| 6-10 | Higher Normal Daytime Sleepiness | Monitor and lifestyle changes |
| 11-12 | Mild Excessive Daytime Sleepiness | Consider further investigation |
| 13-15 | Moderate Excessive Daytime Sleepiness | Active treatment |
| 16-24 | Severe Excessive Daytime Sleepiness | Immediate initiation |
- Prebuilt template with ESS scoring to assess the presence and severity of daytime sleepiness
- 8-item questionnaire that scores each situation based on the likelihood of dozing off
- Real-time calculation of ESS Score and sleepiness 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 sleepiness
- 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 |
| Situation | |
| Sitting and reading | slight chance of dozing |
| Watching TV | moderate chance of dozing |
| Sitting inactive in a public place (e.g., a theater or a meeting) | high chance of dozing |
| As a passenger in a car for an hour without a break | would never doze |
| Lying down to rest in the afternoon when circumstances permit | slight chance of dozing |
| Sitting and talking to someone | moderate chance of dozing |
| Sitting quietly after a lunch without alcohol | high chance of dozing |
| In a car, while stopped for a few minutes in traffic | would never doze |
| ESS Score | 16 |
| Sleepiness Level | Severe Excessive Daytime Sleepiness |
- Pre-populate patient details such as patient id, name, email etc in the ESS assessment form before sharing it with the patients
- Send an email invitation with a secure link for patients to complete their ESS assessment form prior to their visit
- Allow patients to save their progress and complete their ESS assessment form at a later time without losing any responses
- Set up an email template for your ESS assessment and automatically send invitation emails to multiple patients with ease
- Send a confirmation email to the patients with their ESS score, diagnosis, next steps when they submit their ESS assessment
Track patient responses in Google Sheets
| A | B | C | D | E | |
|---|---|---|---|---|---|
| 1 | Name | Question | Answer | Score | Total Score |
| 2 | John W | Sitting and reading | slight chance of dozing | 1 | 16 |
| 3 | John W | Watching TV | moderate chance of dozing | 2 | 16 |
| 4 | John W | Sitting inactive in a public place (e.g., a theater or a meeting) | high chance of dozing | 3 | 16 |
| 5 | John W | As a passenger in a car for an hour without a break | would never doze | 0 | 16 |
| 6 | John W | Lying down to rest in the afternoon when circumstances permit | slight chance of dozing | 1 | 16 |
| 7 | John W | Sitting and talking to someone | moderate chance of dozing | 2 | 16 |
| 8 | John W | Sitting quietly after a lunch without alcohol | high chance of dozing | 3 | 16 |
| 9 | John W | In a car, while stopped for a few minutes in traffic | would never doze | 0 | 16 |
- Export patient responses including the calculated ESS score and sleepiness level to Google Sheets for easy record-keeping
- Export individual points for 8 situations 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 sleepiness symptoms
- Receive a copy of the response and the calculated ESS score by email whenever a patient submits their ESS 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 |
| Situation | |
| Sitting and reading: | slight chance of dozing |
| Watching TV: | moderate chance of dozing |
| Sitting inactive in a public place (e.g., a theater or a meeting): | high chance of dozing |
| As a passenger in a car for an hour without a break: | would never doze |
| Lying down to rest in the afternoon when circumstances permit: | slight chance of dozing |
| Sitting and talking to someone: | moderate chance of dozing |
| Sitting quietly after a lunch without alcohol: | high chance of dozing |
| In a car, while stopped for a few minutes in traffic: | would never doze |
| ESS Score: | 16 |
| Sleepiness Level: | Severe Excessive Daytime Sleepiness |
| ESS Score: | 16 |
| Sleepiness Level: | Severe Excessive Daytime Sleepiness |
- Create a HIPAA compliant ESS 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 ESS form responses to Google Sheets and sending them on email
- Prepopulate patient details in ESS 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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