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Fall Risk Assessment Questionnaire Template

This fall risk assessment questionnaire helps you evaluate an individual’s risk of falling. With this customizable questionnaire with in-built reporting modules, you can easily identify potential risk factors for falling and develop strategies to prevent it. Health care – easy-peasy and hassle-free!

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Reasons you may fall for our Fall Risk Assessment Questionnaire

Gauge fall risks beforehand with our Fall Risk Assessment Questionnaire

With this fall risk assessment questionnaire, you can be assured that any potential falls are prevented, and necessary interventions are taken beforehand. Enriched with highly useful features, this questionnaire is your one-stop solution for meeting the right care for your risk-borne patients. Make the best use of this questionnaire by knowing its cool features right away.

Benefits of Using This Fall Risk Assessment Questionnaire

Conditional Logic

With the skip logic feature, you can show or hide questions based on the respondent’s answers to previous questions. For example, if a respondent indicates they have arthritis, you may want to show follow-up questions about joint pain and mobility. But if they do not have arthritis, those questions may not be necessary. Display logic can also be made use of in a similar manner when you only want to display a particular question if it meets specific, pre-determined criteria.

Mobile-Friendly

The mobile-friendly feature ensures that whoever is accessing the questionnaire, be it a patient or a hospital staff, can view and complete the questionnaire on the device of their choice. Hence, if you as a staff member want to access the form from your hospital computer, you can do that very well. If you’re a patient of a particular hospital, you can choose to fill it out from your laptop.

Multiple Share Options

With SurveySparrow’s seamless and omnichannel survey sharing, distribute your questionnaires easily with your patients. If you want people to receive your forms through SMS, you can text them to their number. If you have a database of their email addresses, you can mail it to them easily, even through email embeds. You can also circulate a URL with the patient or staff. You can even place offline kiosks in your hospital and let the patient fill it out then and there. 

Case Management

Say hello to Case Management by SurveySparrow, a ticketing tool that lets you track, monitor, and act on every case. You can assign priorities based on certain conditions, create specific workflows, track responses in real time, and assign a particular patient to the right doctor or department. This way, you can ensure that all the patients receive immediate care or do not have to wait in a long line to access immediate medical care and attention.

HIPAA Compliance

SurveySparrow is a HIPAA-compliant platform. This will help hospitals to protect patient health data and minimize the risk of any data breaches. Our platform is committed to securing the privacy of your patients in every way possible. SurveySparrow enforces and maintains the appropriate administrative, technical, and physical safeguards for ensuring confidentiality, security, and integrity.

File Upload Feature

Patients can upload their medical history records easily using this fall risk assessment questionnaire template. The file upload feature allows hospitals to collect all relevant documents and helps to better understand patient's health conditions. The physicians can thus give proper diagnoses and thereby improve the patient’s health.

Use this Patient Registration Form Template to register your new patients

What is Fall Risk Assessment?

A fall risk assessment is a process to analyze a patient's risks associated with falling. The assessment is important for older people, and individuals with chronic disorders, or mobility issues. It is conducted to predict the risks beforehand and take necessary precautions.

Why should we conduct a Fall Risk Assessment?

  • To prevent injuries
  • To improve the quality of life
  • For personalized care planning
  • To promote overall health and well-being

Use Cases of This Fall Risk Assessment Questionnaire Template

  • Hospitals and Clinics: During new patient intake, hospitals and clinics can use this template to predict the risk of falling. This helps to assign personalized care plans for your patients.
  • Nursing or Old-age Homes: Identify new risks of falling using this template. It can also be used to reassess resident’s condition and take good care of them.
  • Rehabilitation Centers: The questionnaire helps physical therapists assess patients’ fall risks and design customized rehabilitation programs to improve balance and mobility.

Try this Patient Intake Form Template

How to use this fall risk assessment questionnaire template

Step 1: Customize It As Your Own

Scroll up, click on ‘Use this Template’, and sign up to create a customized questionnaire. Change up the background, font, and even personalize the welcome and thank-you pages according to your choice. Need text inspiration? Let AI Wings rephrase questions or descriptions! 

Step 2: Integrate With Essential Apps

Streamline your workflow by integrating with essential apps. Sync responses to Google Sheets, automate email follow-ups with Mailchimp and unlock a range of possibilities with SurveySparrow’s vast integration library.

Step 3: Share The Questionnaire

Whether it’s through a unique link, website embed, email invite, or a QR code, our platform offers diverse sharing options to reach your patients wherever they are.

Step 4: Analyze Responses

Export responses to CSV for offline analysis and use SurveySparrow’s dashboard for segmentation and visualization. Interpret the questionnaire efficiently for further contact and diagnosis.

More Templates

We hope this fall risk assessment questionnaire is helping you get to the rescue of those much in need of care and treatment. Give your clients the value they deserve the most by checking out our other templates in the gallery. Take a look and try them out for yourself for free. Hurry up now!
View All Templates

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