Use our readymade template to create your Headache Disability Index (HDI) assessment tool
Create your care assessments
| HDI score | Disability Level | Proposed treatment |
|---|---|---|
| 0-9 | No disability | May not need treatment |
| 10-29 | Mild disability | Consider counseling |
| 30-49 | Moderate disability | Consider medication |
| 50-71 | Severe disability | Active treatment |
| 72-100 | Complete disability | Immediate initiation |
- Prebuilt template with HDI scoring to assess the presence of headache disorders and measure their impact
- 25-item questionnaire that scores each item as “Yes” (4 points), “Sometimes” (2 points), or “No” (0 points)
- Real-time calculation of HDI Score and disability level based on the form responses
- Collect patient data and other sensitive healthcare data using our HIPAA compliant online assessment forms
- Compare the scores from the initial screening with that of the followup to track the progression of headache disorders
- Easily create responsive forms that allow patients to complete their assessments on any device at any time
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 |
| I have a headache: | more than once but less than four times per month |
| My headache is: | moderate |
| Because of my headaches I feel disabled. | Sometimes |
| Because of my headaches I feel restricted in performing my routine daily activities. | Yes |
| No one understands the effect my headaches have on my life. | No |
| I restrict my recreational activities (eg, sports, hobbies) because of my headaches. | Yes |
| My headaches make me angry. | Sometimes |
| Sometimes I feel that I am going to lose control because of my headaches. | No |
| Because of my headaches I am less likely to socialize. | Yes |
| My spouse (significant other), or family and friends have no idea what I am going through because of my headaches. | Sometimes |
| My headaches are so bad that I feel that I am going to go insane. | No |
| My outlook on the world is affected by my headaches. | Yes |
| I am afraid to go outside when I feel that a headaches is starting. | Sometimes |
| I feel desperate because of my headaches. | No |
| I am concerned that I am paying penalties at work or at home because of my headaches. | Yes |
| My headaches place stress on my relationships with family or friends. | Sometimes |
| I avoid being around people when I have a headache. | No |
| I believe my headaches are making it difficult for me to achieve my goals in life. | Yes |
| I am unable to think clearly because of my headaches. | Sometimes |
| I get tense (e.g., muscle tension) because of my headaches. | No |
| I do not enjoy social gatherings because of my headaches. | Yes |
| I feel irritable because of my headaches. | Sometimes |
| I avoid traveling because of my headaches. | No |
| My headaches make me feel confused. | Yes |
| My headaches make me feel frustrated. | Sometimes |
| I find it difficult to read because of my headaches. | No |
| I find it difficult to focus my attention away from my headaches and on other things. | Yes |
| Emotional score | 24 |
| Functional score | 20 |
| HDI score | 44 |
| Disability Level | mild disability |
- Pre-populate patient details such as patient id, name, email etc in the HDI assessment form before sharing it with the patients
- Send an email invitation with a secure link for patients to complete their HDI assessment form prior to their visit
- Allow patients to save their progress and complete their HDI assessment form at a later time without losing any responses
- Set up an email template for your HDI assessment and automatically send invitation emails to multiple patients with ease
- Send a confirmation email to the patients with their HDI score, diagnosis, next steps when they submit their HDI assessment
Track patient responses in Google Sheets
| A | B | C | D | E | |
|---|---|---|---|---|---|
| 1 | Name | Question | Answer | Score | Total Score |
| 2 | John W | Because of my headaches I feel disabled. | Sometimes | 2 | 44 |
| 3 | John W | Because of my headaches I feel restricted in performing my routine daily activities. | Yes | 4 | 44 |
| 4 | John W | No one understands the effect my headaches have on my life. | No | 0 | 44 |
| 5 | John W | I restrict my recreational activities (eg, sports, hobbies) because of my headaches. | Yes | 4 | 44 |
| 6 | John W | My headaches make me angry. | Sometimes | 2 | 44 |
| 7 | John W | Sometimes I feel that I am going to lose control because of my headaches. | No | 0 | 44 |
| 8 | John W | Because of my headaches I am less likely to socialize. | Yes | 4 | 44 |
| 9 | John W | My spouse (significant other), or family and friends have no idea what I am going through because of my headaches. | Sometimes | 2 | 44 |
| 10 | John W | My headaches are so bad that I feel that I am going to go insane. | No | 0 | 44 |
| 11 | John W | My outlook on the world is affected by my headaches. | Yes | 4 | 44 |
| 12 | John W | I am afraid to go outside when I feel that a headaches is starting. | Sometimes | 2 | 44 |
| 13 | John W | I feel desperate because of my headaches. | No | 0 | 44 |
| 14 | John W | I am concerned that I am paying penalties at work or at home because of my headaches. | Yes | 4 | 44 |
| 15 | John W | My headaches place stress on my relationships with family or friends. | Sometimes | 2 | 44 |
| 16 | John W | I avoid being around people when I have a headache. | No | 0 | 44 |
| 17 | John W | I believe my headaches are making it difficult for me to achieve my goals in life. | Yes | 4 | 44 |
| 18 | John W | I am unable to think clearly because of my headaches. | Sometimes | 2 | 44 |
| 19 | John W | I get tense (e.g., muscle tension) because of my headaches. | No | 0 | 44 |
| 20 | John W | I do not enjoy social gatherings because of my headaches. | Yes | 4 | 44 |
| 21 | John W | I feel irritable because of my headaches. | Sometimes | 2 | 44 |
| 22 | John W | I avoid traveling because of my headaches. | No | 0 | 44 |
| 23 | John W | My headaches make me feel confused. | Yes | 4 | 44 |
| 24 | John W | My headaches make me feel frustrated. | Sometimes | 2 | 44 |
| 25 | John W | I find it difficult to read because of my headaches. | No | 0 | 44 |
| 26 | John W | I find it difficult to focus my attention away from my headaches and on other things. | Yes | 4 | 44 |
- Export patient responses including the calculated HDI score and disability level to Google Sheets for easy record-keeping
- Export individual points for 25 items to Google Sheets for data manipulation and analysis for comprehensive insights
- Use pre-built reports to easily keep track of patient progress over time and monitor changes in their headache symptoms
- Receive a copy of the response and the calculated HDI score by email whenever a patient submits their HDI assessment
- 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 |
| I have a headache: : | more than once but less than four times per month |
| My headache is: : | moderate |
| Because of my headaches I feel disabled.: | Sometimes |
| Because of my headaches I feel restricted in performing my routine daily activities.: | Yes |
| No one understands the effect my headaches have on my life.: | No |
| I restrict my recreational activities (eg, sports, hobbies) because of my headaches.: | Yes |
| My headaches make me angry.: | Sometimes |
| Sometimes I feel that I am going to lose control because of my headaches.: | No |
| Because of my headaches I am less likely to socialize.: | Yes |
| My spouse (significant other), or family and friends have no idea what I am going through because of my headaches.: | Sometimes |
| My headaches are so bad that I feel that I am going to go insane.: | No |
| My outlook on the world is affected by my headaches.: | Yes |
| I am afraid to go outside when I feel that a headaches is starting.: | Sometimes |
| I feel desperate because of my headaches.: | No |
| I am concerned that I am paying penalties at work or at home because of my headaches.: | Yes |
| My headaches place stress on my relationships with family or friends.: | Sometimes |
| I avoid being around people when I have a headache.: | No |
| I believe my headaches are making it difficult for me to achieve my goals in life.: | Yes |
| I am unable to think clearly because of my headaches.: | Sometimes |
| I get tense (e.g., muscle tension) because of my headaches.: | No |
| I do not enjoy social gatherings because of my headaches.: | Yes |
| I feel irritable because of my headaches.: | Sometimes |
| I avoid traveling because of my headaches.: | No |
| My headaches make me feel confused.: | Yes |
| My headaches make me feel frustrated.: | Sometimes |
| I find it difficult to read because of my headaches.: | No |
| I find it difficult to focus my attention away from my headaches and on other things.: | Yes |
| Emotional score: | 24 |
| Functional score: | 20 |
| HDI score: | 44 |
| Disability Level: | mild disability |
| HDI score: | 44 |
| Disability Level: | mild disability |
- Create a HIPAA compliant HDI assessment form to safely collect, store and access patient responses
- Mark fields as Protected Health Information (PHI) to secure sensitive patient data and limit access to PHI
- Automatically mask PHI fields when exporting HDI form responses to Google Sheets and sending them on email
- Prepopulate patient details in HDI assessments by creating secure prefill links without exposing PHI
- Limit access to patient data only for authorized personnel and minimize the risk of data breaches
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