DASH Upper Extremity Outcome Measure

Standardized form to administer the DASH questionnaire for arm, shoulder, and hand function at evaluation and reassessment.

Visit Context

• Assessment date
• Assessment type
• Primary body region
• Diagnosis category
• If other, specify diagnosis category
• Clinician name
  Optional. Collect only if needed for audit trail or local workflow.

DASH Questionnaire

• Open a tight or new jar
• Do heavy household chores
• Carry a shopping bag or briefcase
• Wash your back
• Use a knife to cut food
• Participate in recreational activities requiring force or impact through the arm, shoulder, or hand
• Social activities with friends or family
• Work or regular daily activities

Symptoms and Impact

• Average pain in the past week
• Numbness or tingling in the arm, shoulder, or hand
• Describe any activities limited by the condition
  Optional free text for clinical context. Do not include unnecessary PII.

Scoring and Follow-up

• DASH total score
  If your workflow calculates the score automatically, store the final DASH score here.
• Compared to previous assessment
• Follow-up plan