> ## Documentation Index
> Fetch the complete documentation index at: https://help.clinikehr.com/llms.txt
> Use this file to discover all available pages before exploring further.

# Scored measures

> How each clinical questionnaire is scored, what the number on the Measures tab means, and why an older score can say it used the previous rule.

export const StillStuck = ({topic}) => <div className="ck-callout ck-callout--note" role="note">
    <p className="ck-callout__body">
      <strong>Still stuck{topic ? ` with ${topic}` : ''}?</strong>{' '}
      Check <a href="/platform/help/troubleshooting">Troubleshooting</a> first —
      it covers the failures we see most often. If that does not resolve it,{' '}
      <a href="/platform/help/contact-support">contact support</a> and include
      your workspace name and the time the problem happened, so we can find the
      matching entry in your audit log.
    </p>
  </div>;

export const Path = ({steps = []}) => <span className="ck-path">
    {steps.map((s, i) => <span key={i} className="ck-path__step">
        {i > 0 ? <span className="ck-path__sep" aria-hidden="true">
            ›
          </span> : null}
        {s}
      </span>)}
  </span>;

export const Availability = ({editions = ['all'], plans, roles, note}) => {
  const list = editions.includes('all') ? ['clinic', 'pharmacy', 'lims'] : editions;
  return <div className="ck-avail" role="note" aria-label="Feature availability">
      <span className="ck-avail__label">Available in</span>

      {list.map(e => <span key={e} className={`ck-pill ck-pill--${e}`}>
          {EDITION_LABELS[e] || e}
        </span>)}

      {plans ? <span className="ck-avail__label">Plan</span> : null}
      {plans ? <span className="ck-pill ck-pill--plan">{plans}</span> : null}

      {roles ? <span className="ck-avail__label">Who</span> : null}
      {roles ? <span className="ck-pill ck-pill--role">{roles}</span> : null}

      {note ? <span className="ck-avail__note">{note}</span> : null}
    </div>;
};

<Availability editions={['clinic']} plans="Essential plan and above" roles="Owner, manager, or staff with the Create and edit forms permission to choose a measure; anyone who can open the client chart to read the scores" />

A scored measure is a clinical questionnaire — a PHQ-9, a GAD-7, a DASH — whose answers add up to a score. The score lands on the **Measures** tab of the patient's chart, where each measure has its own chart over time.

<Path steps={['Sidebar', 'Forms', 'A form', 'Settings', 'Clinical measure']} />

## Make a form a scored measure

<Steps>
  <Step title="Choose the measure">
    On the form's **Settings** tab, under **Clinical measure**, choose it in **What this form measures**. Each measure in the list says what it is scored out of.
  </Step>

  <Step title="Give each question its scale">
    Mark a choice question with **Points per option**, so each answer carries the number the questionnaire gives it. A number, scale or rating question scores the number the patient enters. Questions that are not part of the questionnaire — a name, a date — are left out of the score.
  </Step>

  <Step title="Send it to a patient">
    When the patient's response arrives, the score is added to their chart. A questionnaire a patient signs from their documents is scored the same way.
  </Step>
</Steps>

## How each measure is scored

Seven measures are scored the way their authors publish them:

| Measure       | How the score is worked out                                                                       | What the number means                                                                                                                                                                                              |
| ------------- | ------------------------------------------------------------------------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ |
| **PEG**       | The average of the three answers                                                                  | 0 to 10. Higher means more pain and more interference. No bands are published.                                                                                                                                     |
| **SWLS**      | The five answers added together                                                                   | 5 to 35. 31–35 extremely satisfied, 26–30 satisfied, 21–25 slightly satisfied, 20 neutral, 15–19 slightly dissatisfied, 10–14 dissatisfied, 5–9 extremely dissatisfied.                                            |
| **ASRS v1.1** | A screen on the first six questions                                                               | Questions 1 to 3 count at **Sometimes** or more, questions 4 to 6 at **Often** or more. Four or more is a **Positive screen**. The other twelve questions are kept with the response but do not change the screen. |
| **CUDOS**     | All 18 answers added together                                                                     | 0 to 72. 0–10 non-depressed, 11–20 minimal, 21–30 mild, 31–45 moderate, 46 and above severe.                                                                                                                       |
| **DASS-21**   | Three scores — Depression, Anxiety and Stress — each its seven answers added together and doubled | Each is out of 42 and has its own bands, below. There is no single total.                                                                                                                                          |
| **DASH**      | The average answer, less 1, multiplied by 25                                                      | 0 to 100. Higher means more disability. Up to three questions may be left blank.                                                                                                                                   |
| **DES-II**    | The average of the 28 answers                                                                     | 0 to 100. 30 or more is at or above the usual screening cut-off.                                                                                                                                                   |

The DASS-21 bands, each on its 0 to 42 score:

| Band                 | Depression   | Anxiety      | Stress       |
| -------------------- | ------------ | ------------ | ------------ |
| **Normal**           | 0–9          | 0–7          | 0–14         |
| **Mild**             | 10–13        | 8–9          | 15–18        |
| **Moderate**         | 14–20        | 10–14        | 19–25        |
| **Severe**           | 21–27        | 15–19        | 26–33        |
| **Extremely Severe** | 28 and above | 20 and above | 34 and above |

The other ten — **PHQ-9**, **GAD-7**, **PCL-5**, **AUDIT**, **PHQ-15**, **WSAS**, **DAST-10**, **EAT-26**, **EAT-10** and **ACE** — are scored as they always have been.

<Note>
  A band or a positive screen describes a score. It is not a diagnosis.
</Note>

## When a response is recorded but not scored

A response is kept, but given no number, when it cannot be scored the way the questionnaire is published:

* The form has a different number of scored questions — a CUDOS with 16 questions instead of 18, for example.
* An answer is outside the questionnaire's scale — a 0 on the SWLS, whose answers run 1 to 7, or a 35 on the DES-II, whose answers go up in tens.
* Too many questions were left blank.

It appears under **Recorded but not scored** on that measure's chart, with the reason and the date. No score is better than a wrong one.

## The CUDOS and DES-II questionnaires in your document library

The **CUDOS** and **DES-II** you send from your document library now use the questions as their authors publish them:

* **CUDOS** has all 18 questions, each answered 0 to 4, so a completed one is scored out of 72. The version it replaces had 16 questions, several of which the CUDOS does not ask, so those responses are recorded but not scored.
* **DES-II** asks its 28 questions in the published wording and order, and each is answered by choosing a percentage from 0% to 100% in steps of ten.

Both name their authors in the instructions. **Documents and responses made from the earlier versions are not changed** — each keeps the questions the patient actually answered.

## Scores recorded before the change

DASH, CUDOS, DES-II, PEG, DASS-21, ASRS and SWLS used to be scored differently — a PEG, for example, was the three answers added together, out of 30. **Nothing already on a chart has been changed.** Each score keeps the rule it was scored under.

A chart of scores made under the old rule is headed **Scored under the previous rule**. New scores start a chart of their own, so a PEG out of 30 and a PEG out of 10 are never drawn on the same line.

## Reading the arrows

Beside each chart, **Since Baseline** and **Since Last** show how many points the score has moved since the first and the previous assessment. The arrow shows which way the number went; the colour shows whether that is good **for that questionnaire**:

* For most measures a lower score is better — fewer symptoms, less disability, less risk — so a fall is green and a rise is red.
* For **SWLS** a higher score is better, because it measures how satisfied someone is with their life — so a rise is green.
* **ACE** counts difficult experiences in childhood, so a change is a correction to the history rather than an improvement or a decline. Its arrow has no colour.
* No change shows a flat line and **No change**.

## Troubleshooting

<AccordionGroup>
  <Accordion title="A CUDOS response says it was not scored">
    The CUDOS has 18 questions. A version with a different number — including the earlier 16-question CUDOS in the document library — is recorded without a score, and the reason says how many it had. Send the current CUDOS from your document library, or build the form with all 18 questions, each marked 0 to 4.
  </Accordion>

  <Accordion title="A patient has two charts for the same measure">
    One holds scores made under the previous rule and is headed so. The two are kept apart because their numbers are on different scales.
  </Accordion>

  <Accordion title="A DASS-21 has no single score">
    DASS-21 gives three scores — Depression, Anxiety and Stress — so its card shows three charts, each out of 42.
  </Accordion>

  <Accordion title="An SWLS response shows no score">
    Every SWLS answer runs from 1 to 7, and all five must be answered. A form that allowed a 0, or a response with a question left blank, is recorded without a score.
  </Accordion>
</AccordionGroup>

<StillStuck />