QUICKDASH RESULT

Date: [Date]
Patient: [Name or ID, age, dominant hand]
Condition: [Diagnosis, side, date of injury or surgery]
Visit: [Baseline, reassessment, or discharge; weeks since injury or surgery]
Version: [QuickDASH 11 items or DASH 30 items, official form; language version]
Completed by: [Patient on paper, patient on a tablet, or with help; interpreter if used]

SCORE
Items answered: [Number out of 11, or out of 30 for the DASH]
Disability and symptom score: [0 to 100, to one decimal place]
Descriptive level: [Minimal, mild, moderate, severe, or very severe]
Work module: [0 to 100, or not given]
Sports or performing arts module: [0 to 100, or not given]

CHANGE
Baseline: [Date and score]
Last score: [Date and score]
Change from baseline: [Points up or down, and whether it is beyond measurement error]

INTERPRETATION
Hardest tasks: [What the patient finds hardest now, in their words]
Findings alongside: [Range of motion, grip strength, pain rating, special tests, imaging]
Impression: [What the score adds to the clinical picture]

PLAN
Next step: [Continue, progress, change treatment, refer, or discharge]
Work and activity: [Full duties, modified duties, sport or hobby, and any limits]
Goal: [Target score or task, and by when]
Repeat QuickDASH: [Date or interval]

Clinician: [Name, credentials]