Upper Extremity Functional Index
22 reviews
57K+
Installs

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
  • navigate_next Prebuilt template with UEFI scoring to assess the level of difficulty an individual has with their upper limb
  • navigate_next 20-item questionnaire that scores each item from “0” (unable to perform activity) to “4” (no difficulty)
  • navigate_next Real-time calculation of UEFI Score based on the form responses
  • navigate_next Collect patient data and other sensitive healthcare data using our HIPAA compliant online assessment forms
  • navigate_next 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
  • navigate_next Allow patients to fill in their details such as patient id, name, email etc in the UEFI assessment form
  • navigate_next Send an email invitation with a secure link for patients to complete their UEFI assessment form prior to their visit
  • navigate_next Allow patients to save their progress and complete their UEFI assessment form at a later time without losing any responses
  • navigate_next Set up an email template for your UEFI assessment and automatically send invitation emails to multiple patients with ease
  • navigate_next 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
  • navigate_next Export patient responses including the calculated UEFI score to Google Sheets for easy record-keeping
  • navigate_next Export individual points for each item to Google Sheets for data manipulation and analysis for comprehensive insights
  • navigate_next Use pre-built reports to easily keep track of patient progress over time and monitor changes in their upper limb functionality
  • navigate_next Receive a copy of the response and the calculated UEFI score by email whenever a patient submits their UEFI assessment
  • navigate_next 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
  • navigate_next Create a HIPAA compliant UEFI assessment form to safely collect, store and access patient responses
  • navigate_next Mark fields as Protected Health Information (PHI) to secure sensitive patient data and limit access to PHI
  • navigate_next Automatically mask PHI fields when exporting UEFI form responses to Google Sheets and sending them on email
  • navigate_next Prepopulate patient details in UEFI assessments by creating secure prefill links without exposing PHI
  • navigate_next 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

5 stars

I am not tech savvy. I chose formesign to help create registration links for clients. Vipid has been great in assisting me. He goes above and beyond. My company now has moved from the stone age to modern age through the ability to use this feature. Of the many features I am impressed with, the ability to update a form without needing to regenerate a link is amazing. I often make mistakes and that ability allows me to fix mistakes without needing to change everything. Thank you!!!

— Sol Evans

February 16, 2024

1 stars

Does not work

— Myles Sicuro

October 31, 2023

5 stars

We needed a way to create forms with e-signatures and this app made it very easy. Support is also very quick and always helpful. Cannot recommend enough!

— Chris Henesy

July 12, 2023

5 stars

It very friendly to used. I love it. For my case multiple signature needed. it's supporting

— Senthil Kumar

November 27, 2023

5 stars

Yeah this is good for all

— luqman Khan

July 10, 2023

5 stars

We were looking for a way to have a signature option in our form. Formesign addon allowed us to collect signatures for the acknowledgment and consent forms. It was simple and easy to setup. Very useful addon for google forms.

— Joan S

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