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Run: DASH Upper Extremity Outcome Measure

The DASH Upper Extremity Outcome Measure template captures arm, shoulder, and hand function at evaluation and reassessment. Use it to standardize patient-rep...

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Visit Context

Assessment date (required)

Assessment type (required)

Primary body region (required)

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 (required)

Do heavy household chores (required)

Carry a shopping bag or briefcase (required)

Wash your back (required)

Use a knife to cut food (required)

Participate in recreational activities requiring force or impact through the arm, shoulder, or hand (required)

Social activities with friends or family (required)

Work or regular daily activities (required)

Symptoms and Impact

Average pain in the past week (required)

Numbness or tingling in the arm, shoulder, or hand (required)

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

Get your results

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Email (required)

Your name (optional)

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