Use our readymade template to create your FLACC Behavioral Pain Scale
Create your care assessments
| FLACC score | Level of Pain | Proposed treatment |
|---|---|---|
| 0 | Relaxed and comfortable | May not need treatment |
| 1-3 | Mild discomfort | Watchful waiting |
| 4-6 | Moderate pain | Consider medication |
| 7-10 | Severe discomfort/pain | Immediate initiation |
- Prebuilt template with FLACC scoring to assess the presence of pain and measure its severity
- 5-item questionnaire that scores each of the 5 criteria as “0” (relaxed and comfortable) to “2” (severe discomfort/pain)
- Real-time calculation of FLACC Score and pain 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 pain
- 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 |
| Face | Frequent to constant quivering chin, clenched jow |
| Legs | Kicking or legs drawn up |
| Activity | Arched, rigid or jerking |
| Cry | Crying steadily, screams, sobs, frequent complaints |
| Consolability | Difficult to console or comfort |
| FLACC Score | 10 |
| Level of Pain | Severe discomfort/pain |
- Pre-populate patient details such as patient id, name, email etc in the FLACC assessment form before sharing it with the patients
- Send an email invitation with a secure link for patients to complete their FLACC assessment form prior to their visit
- Allow patients to save their progress and complete their FLACC assessment form at a later time without losing any responses
- Set up an email template for your FLACC assessment and automatically send invitation emails to multiple patients with ease
- Send a confirmation email to the patients with their FLACC score, diagnosis, next steps when they submit their FLACC assessment
Track patient responses in Google Sheets
| A | B | C | D | E | |
|---|---|---|---|---|---|
| 1 | Name | Question | Answer | Score | Total Score |
| 2 | John W | Face | Frequent to constant quivering chin, clenched jow | 2 | 10 |
| 3 | John W | Legs | Kicking or legs drawn up | 2 | 10 |
| 4 | John W | Activity | Arched, rigid or jerking | 2 | 10 |
| 5 | John W | Cry | Crying steadily, screams, sobs, frequent complaints | 2 | 10 |
| 6 | John W | Consolability | Difficult to console or comfort | 2 | 10 |
- Export patient responses including the calculated FLACC score and pain level to Google Sheets for easy record-keeping
- Export individual points for 5 criteria 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 pain symptoms
- Receive a copy of the response and the calculated FLACC score by email whenever a patient submits their FLACC 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: | ****** |
| Face: | Frequent to constant quivering chin, clenched jow |
| Legs: | Kicking or legs drawn up |
| Activity: | Arched, rigid or jerking |
| Cry: | Crying steadily, screams, sobs, frequent complaints |
| Consolability: | Difficult to console or comfort |
| FLACC Score: | 10 |
| Level of Pain: | Severe discomfort/pain |
| FLACC Score: | 10 |
| Level of Pain: | Severe discomfort/pain |
- Create a HIPAA compliant FLACC 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 FLACC form responses to Google Sheets and sending them on email
- Prepopulate patient details in FLACC 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
These reviews are reproduced without modification from Google Workspace Marketplace.
July 23, 2023
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
October 31, 2023
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
February 16, 2024
Does not work
— Myles Sicuro
July 12, 2023
It very friendly to used. I love it. For my case multiple signature needed. it's supporting
— Senthil Kumar
November 27, 2023
Yeah this is good for all
— luqman Khan
July 10, 2023
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