Stroke Assessment (NIH Stroke Scale)
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Stroke Assessment (NIH Stroke Scale)
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The Stroke Assessment Form implements the National Institutes of Health Stroke Scale (NIHSS), the most widely used standardized instrument for quantifying neurological deficit severity in acute stroke patients. It systematically evaluates 11 domains , level of consciousness (including orientation and command response), best gaze, visual fields, facial palsy, motor function in each extremity, limb ataxia, sensory function, language (aphasia), dysarthria, and extinction/inattention (neglect). Each item is scored on a defined ordinal scale, producing a total NIHSS score that correlates with stroke severity, guides acute treatment decisions such as thrombolytic eligibility, and predicts long-term outcome.
Beyond the core NIHSS items, this template captures essential acute stroke workflow data including symptom onset time (last known well), current blood pressure and glucose readings, stroke type classification (ischemic vs. hemorrhagic), and imaging findings. It documents the time-critical decision points for thrombolytic therapy (tPA) or endovascular intervention eligibility, including contraindication screening. A section for recording serial NIHSS scores at defined intervals (baseline, 2 hours, 24 hours, discharge) supports monitoring of neurological trajectory, enabling early detection of clinical improvement or deterioration that may require intervention.
Designed for emergency departments, stroke centers (primary and comprehensive), neurology inpatient services, and telestroke programs, this form supports compliance with Get With The Guidelines-Stroke (GWTG-Stroke) quality measures and Joint Commission Primary Stroke Center certification requirements. It provides the rapid, reproducible neurological assessment framework that stroke teams need to make time-sensitive treatment decisions while maintaining the documentation quality required for quality reporting, outcome tracking, and clinical research.
What's included
- Complete 11-domain NIH Stroke Scale with standardized ordinal scoring
- Symptom onset time and acute stroke workflow timestamps
- Serial NIHSS scoring for baseline, post-treatment, and discharge evaluations
- Level of consciousness, motor, sensory, language, and neglect assessments
- Total NIHSS score with severity classification
- Examiner signature and time-stamped documentation
Who uses this template
- 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
All form fields
17 fields across 3 pages. Customize any field after signing up.
How to use the Stroke Assessment (NIH Stroke Scale)
Getting started with this template takes just a few minutes. Sign up for a free Formisoft trial, then select the Stroke Assessment (NIH Stroke 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 Stroke Assessment (NIH Stroke 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 17 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 Stroke Assessment (NIH Stroke Scale) HIPAA compliant?
Yes. All Formisoft templates, including the Stroke Assessment (NIH Stroke 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 17 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 Stroke Assessment (NIH Stroke 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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