Epworth Sleepiness Scale
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Epworth Sleepiness Scale
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The Epworth Sleepiness Scale (ESS) form digitizes the most widely used subjective measure of daytime sleepiness, developed by Dr. Murray Johns at the Epworth Hospital in Melbourne. The eight-item questionnaire asks patients to rate their likelihood of dozing off in common daily situations on a 0-3 scale (would never doze, slight chance, moderate chance, high chance). Situations include sitting and reading, watching television, sitting inactive in a public place, riding as a passenger, lying down to rest in the afternoon, sitting and talking, sitting quietly after lunch, and stopping in traffic.
The total score ranges from 0 to 24, with established clinical thresholds: normal (0-10), mild excessive daytime sleepiness (11-14), moderate (15-17), and severe (18-24). Scores above 10 suggest a level of daytime sleepiness that warrants clinical evaluation for underlying sleep disorders such as obstructive sleep apnea, narcolepsy, idiopathic hypersomnia, or insufficient sleep syndrome. The digital format includes fields for the total and maps it to severity categories.
This template is essential for sleep medicine clinics, pulmonology practices, primary care settings evaluating fatigue complaints, and occupational health programs assessing fitness for duty in safety-sensitive positions. The ESS is frequently used as both a screening tool and a treatment outcome measure, allowing clinicians to track improvement in sleepiness following interventions such as CPAP therapy, medications, or behavioral changes. It is recommended by the American Academy of Sleep Medicine as part of the standard sleep evaluation.
What's included
- All eight validated ESS situational items
- Standardized 0-3 dozing likelihood scale
- Automatic total score and severity calculation
- Clinical threshold interpretation guide
- Sleep history and current treatment context
- Provider notes and referral documentation
Who uses this template
- Sleep medicine clinic initial evaluation
- Primary care fatigue and sleepiness complaints
- CPAP therapy and sleep treatment outcome monitoring
- Occupational health fitness-for-duty screening
All form fields
12 fields across 1 page. Customize any field after signing up.
How to use the Epworth Sleepiness Scale
Getting started with this template takes just a few minutes. Sign up for a free Formisoft trial, then select the Epworth Sleepiness Scale from the template library. The form is ready to use immediately, but you can customize every field, add your practice logo, and adjust the layout to match your workflow.
Setup steps
- 1Choose the template. Find the Epworth Sleepiness Scale in the template library and click “Use this template” to add it to your account.
- 2Customize fields. Add, remove, or reorder any of the 12 fields. Set fields as required or optional based on your practice needs.
- 3Brand it. Upload your logo, pick your colors, and add a custom welcome message so patients see your practice identity.
- 4Share with patients. Send the form via SMS, email, or embed it on your website. Patients complete it on any device before their visit.
- 5Review submissions. Responses appear in your dashboard in real time. Patient records are created automatically from the data collected.
Frequently asked questions
Is the Epworth Sleepiness Scale HIPAA compliant?
Yes. All Formisoft templates, including the Epworth Sleepiness Scale, are HIPAA compliant. Data is encrypted with 256-bit AES at rest and TLS 1.3 in transit. A Business Associate Agreement (BAA) is included on every plan.
Can I customize the fields in this template?
Absolutely. You can add, remove, reorder, or modify any of the 12 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.
How do patients fill out this form?
Patients receive a link via SMS, email, or QR code. They complete the form on their phone, tablet, or computer before their appointment. No app download required.
Can I send this form automatically before appointments?
Yes. Formisoft's workflow automation can send intake forms automatically when an appointment is booked. You can set the timing (e.g., 48 hours before the visit) and include reminders for patients who haven't completed it.
Does this template work on mobile devices?
Yes. The Epworth Sleepiness Scale is fully responsive and works on any device. Most patients complete intake forms on their phone, so every template is optimized for mobile-first use.
Start with this template
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