Physical Functional Ability (FAQ5) Score
Physical Functional Ability (FAQ5) Score [select name="Q1" value="1. Require total care: for bathing, toilet, dressing, moving and eating=1|2. Require frequent assistance=2|3. Require occasional assistance=3|4. Independent with self-care=4"] <--Self-care ability assessment [select name="Q2" value="1. Unable to perform any: chores, hobbies, driving, sex and social activities=1|2. Able to perform some=2|3. Able to perform many=3|4. Able to perform all=4"] <-- Family and social ability assessment [select name="Q3" value="1. Able to get up and walk with assistance, unable to climb stairs=1|2. Able to get up and walk independently, able to climb one flight of stairs=2|3. Able to walk short distances and climb more than one flight of stairs=3|4. Able to walk long distances and climb stairs without difficulty=4"] <-- Movement ability assessment [select name="Q4" value="1. Able to lift up to 10 lbs. occasionally=1|2. Able to lift up to 20 lbs. occasionally=2|3. Able to lift up to 50 lbs. occasionally=3|4. Able to lift over 50 lbs. occasionally=4"] <-- Lifting ability assessment [select name="Q5" value="1. Unable to do any work=1|2. Able to work part-time and with physical limitations=2|3. Able to work part-time or with physical limitations=3|4. Able to perform normal work=4"] <-- Work ability assessment Physical Functional Ability (FAQ5) Score --> [calc memo="score" value="score1=((Q1)+(Q2)+(Q3)+(Q4)+(Q5))*5"] / 100 [checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).is('')"] reference: [link url="//www.icsi.org/_asset/bw798b/ChronicPain.pdf" memo="#1"] Peter S Marshall MD MPH - Institute for Clinical Systems Improvement (ICSI) Chronic Pain Guideline [/conditional]
There are 9 form elements.
Result - Copy and paste this output:
Sandbox Metrics: Structured Data Index 1, 5 form elements, 173 boilerplate words, 1 checkboxes, 1 drop downs, 1 links, 1 calculations, 1 conditionals, 2 total clicks
More SOAPnotes by this Author:
Send Feedback for this SOAPnote
You must be logged in to post a comment.