Outcome measures put a number on how a client is doing. They live on the client's Notes tab in the Measures view; the strip of tiles at the top of the Notes tab shows the latest score, a pending questionnaire, or an unacknowledged risk flag.
The measures
| Measure | What it measures | Items | Score | Bands | Better is |
|---|---|---|---|---|---|
| PHQ-9 | Depression, last 2 weeks | 9, scored 0–3 | 0–27 | Minimal 0–4 · Mild 5–9 · Moderate 10–14 · Moderately severe 15–19 · Severe 20–27 | Lower |
| GAD-7 | Anxiety, last 2 weeks | 7, scored 0–3 | 0–21 | Minimal 0–4 · Mild 5–9 · Moderate 10–14 · Severe 15–21 | Lower |
| PCL-5 | PTSD, past month | 20, scored 0–4 | 0–80 | Below threshold 0–30 · Probable PTSD 31–80, plus cluster subscores B, C, D, E | Lower |
| AUDIT | Alcohol use | 10 | 0–40 | Low risk 0–7 · Hazardous 8–15 · Harmful 16–19 · Possible dependence 20–40 | Lower |
| AUDIT-C | Alcohol consumption, past year | 3 | 0–12 | Negative screen 0–2 · Positive screen (women) 3 · Positive screen 4–12 | Lower |
| DASS-21 | Depression, anxiety and stress, past week | 21, scored 0–3 | Each scale 0–42 (doubled) | Normal to Extremely severe, shown per scale | Lower |
| C-SSRS | Suicide risk screener, past month | 6, yes/no | 0–3 | No risk identified 0 · Low 1 · Moderate 2 · High 3 | Lower |
| NPRS | Pain now, best and worst in 24 hours | 3, scored 0–10 | 0–10 (average) | No pain 0 · Mild 1–3 · Moderate 4–6 · Severe 7–10 | Lower |
| LEFS | Lower extremity function | 20, scored 0–4 | 0–80 | Severe limitation 0–19 · Substantial 20–39 · Moderate 40–59 · Mild or none 60–80 | Higher |
| UEFI-20 | Upper extremity function | 20, scored 0–4 | 0–80 | Same four bands as LEFS | Higher |
| RMDQ (Roland-Morris) | Low back disability today | 24, yes/no | 0–24 | Mild 0–8 · Moderate 9–16 · Severe 17–24 | Lower |
| ABC | Balance confidence | 16, 0–100% | 0–100 (average) | Low functioning 0–49 · Moderate 50–80 · High functioning 81–100 | Higher |
| Berg Balance | Clinician-observed balance | 14 tasks, scored 0–4 | 0–56 | High fall risk 0–20 · Medium 21–40 · Low 41–56 | Higher |
When you send or enter a measure, the ones for your practice type come first under Recommended for your practice (for example the PT scales for a physical therapy clinic, PHQ-9 and GAD-7 for a mental health practice), and the rest follow under Other instruments. Function and balance scales show "higher is better" so a rising trend reads the right way.
The Oswestry Disability Index, Neck Disability Index and QuickDASH are not included because they are licensed for use in commercial software.
Send a measure
- Open the client → Notes → Measures → Send a measure.
- Pick the measure, keep Send to the client (text and email with a link) selected, set an optional Due by date, and click Send.
The client gets a text and an email ("A short questionnaire from your care team") with a private link, and their portal Home lists "Complete the PHQ-9 questionnaire". Sent between 9pm and 8am in the client's time, the email goes at once and the text waits until 8am their time. The card lists it under Pending with the sent and due dates; from there you can Enter answers for them or Cancel it.
You can also send measures together with consents and forms from Send documents; they are grouped under Scored measures. See Send documents to clients.
The client's side
The link opens the questionnaire with no login. Every item must be answered before it can be sent. The client then sees a thank-you. They never see a score or a band.
Enter in session
Enter in session (or Enter answers now in the send dialog) opens the items in a modal for paper or verbal answers. Score and save stores it as a staff entry, scored and trended like any other. Staff entries do not notify anyone.
Berg Balance is clinician-scored: choosing it switches to in-session entry with the note "Berg Balance is scored by the clinician, so it is entered in session rather than sent." It cannot be sent or scheduled.
Scores, trends, and the result screen
Scoring happens on completion. The card shows the score, the band, and a trend line once there are two completions of the same measure. The note editor's progress section shows the latest score of each measure beside the treatment goals.
Click a point on the trend (or a flag) to open the result:
- Score (a gauge) and Scoring interpretation, for example "Scores from 10–14 indicate Moderate." DASS-21 lists each scale. View scoring guide opens the full band table.
- Every answer with its score, the change Since last and Since baseline, and "reading 3 of 5" in the header.
- Note adds a clinician note ("Note on this result"), Sign signs the review, Print saves a PDF, and Delete removes the result from the measures and trend (the record stays in the audit log).
Risk flags
These raise a risk flag:
| Measure | Trigger |
|---|---|
| PHQ-9 | Item 9 (thoughts of self-harm) above "Not at all" |
| PCL-5 | Item 16 (risk-taking or self-harm) at "Quite a bit" or "Extremely" |
| DASS-21 | Item 21 (life feels meaningless) at 2 or higher |
| C-SSRS | "Yes" on item 2 (thoughts of killing themselves), or a score of 3: "High suicide risk (C-SSRS): review now" |
| Berg Balance | A score of 45 or below: elevated fall risk |
The treating provider is notified at once, the Measures card and the strip at the top of the Notes tab show it, and a Risk flag task appears under Tasks → Clinical marked urgent. Acknowledge on the card or the task's check button clears it, and the acknowledgement is recorded. The C-SSRS opens with the 988 and 911 crisis lines for the client.
Schedule it
The calendar button on the card (Schedule measures) opens Measure schedule. Add a row per measure (up to 10 per client) and pick how often:
- Before each visit or Before every other visit: sent in the 24 hours before a booked visit.
- After each visit: sent 20 minutes after the visit starts.
- Every week, Every two weeks, Every four weeks, Every month, or Every three months: sent at 9am the client's time, due a week later. A new one is not sent while the last is still open.
Cancelled and missed visits never trigger a send. The client is reminded once a day later, anything still open after two weeks expires, and nothing is sent to a discharged client. You can set the same thing from Send documents: tick the measure and choose Before every appointment, Before every other appointment, After every appointment, Every 2 weeks or Every 4 weeks (the last two with a start date; "First share: today" sends one now too).
Default measures
To have a measure ticked every time you send documents, open Settings → Documentation → Shareable documents. Under Default intake package, each scored measure has a switch: Default pre-selects it in Send documents, Manual only leaves it for you to tick. A measure already waiting for the client is not ticked again.
Notifications and access
A risk flag notifies the treating provider immediately; a questionnaire the client completes without a flag sends a quieter "completed" notification. Sending, entering, and cancelling measures needs clinical authoring access; reading them needs clinical read access, which front-desk logins do not have. Every assignment and result is written to the HIPAA Audit Log (Settings → Account Activity).