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Stroke Assessment (NIH Stroke Scale)

Asks about symptom onset / last known well, level of consciousness, and LOC questions (Orientation). Built for emergency department acute stroke severity assessment and thrombolytic eligibility screening.

Questions
17
Pages
2
Time
about 4 min

Includes

  • E-signature
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Stroke Assessment (NIH Stroke Scale)

Page 1 of 2 · Your information

Live preview. Tap through it like a patient.

Who it is for

  • Emergency department acute stroke severity assessment and thrombolytic eligibility screening
  • Stroke center serial neurological monitoring at defined post-treatment intervals
  • Telestroke program remote neurological assessment and treatment recommendation support
  • Stroke quality improvement program data collection and GWTG-Stroke measure compliance

What's inside

Before you publish: Clinical review required: this worksheet does not calculate scores, diagnose, or recommend treatment. Confirm the questions and response options against your approved assessment protocol before use.

Page 1 · Your information

  1. Full NameText · Required
  2. Symptom Onset / Last Known WellText
  3. Level of ConsciousnessLong Text
  4. LOC Questions (Orientation)Long Text
  5. LOC CommandsLong Text

Page 2 · Additional details

  1. Motor Leg (Left/Right)Long Text
  2. Limb AtaxiaLong Text
  3. SensoryLong Text
  4. Language (Aphasia)Long Text
  5. DysarthriaLong Text

From form to a ready patient

  1. The Formisoft form builder with editable questions and required toggles

    01

    Make it yours

    Reword, reorder, or add to the Stroke Assessment (NIH Stroke Scale), and add your logo.

  2. A patient filling out a Formisoft form on a phone

    02

    Patients finish it at home

    A secure link by text or email, filled out on their phone before the visit. No app.

  3. The Formisoft dashboard showing how many of today's patients are ready

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    Your team sees who is ready

    Each visit shows as ready once its forms are in. Answers land on the patient record.

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Questions

Formisoft provides secure form collection and a Business Associate Agreement (BAA). Your practice must review the form content, access permissions, and sharing workflow for its requirements.

Yes. You can add, remove, reorder, or reword any of the 17 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.

Patients open a secure link from an email, a text, or a QR code and complete the form on their phone, tablet, or computer before their appointment. No app download required.

Yes, on Front Desk. Attach the form to a visit type and every patient who books gets it right away, with a reminder before the visit if it is not done. Your calendar shows which visits are ready.

Yes. The Stroke Assessment (NIH Stroke Scale) works on any device. Most patients complete intake forms on their phone, so every template is built for small screens first.

Send it before the visit, so patients arrive ready.

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