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Run: Lower Extremity Functional Scale Tracking

Track LEFS scores, compare them to a prior baseline, and document whether the change is likely meaningful. This template also captures side, clinician, and p...

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Assessment Details

Assessment date (required)

Date the LEFS was completed.

Assessment type (required)

Select the visit context for this LEFS entry.

Primary side affected

Optional laterality to support clinical interpretation.

Clinician name

Optional if your workflow needs an audit trail for the assessor.

LEFS Score

LEFS total score (required)

Enter the total LEFS score from 0 to 80.

Previous LEFS score

Optional prior score for comparison and trend review.

Change from previous score

Calculated difference between the current and previous LEFS score.

Change interpretation

A change of 9 points is the minimal detectable change for LEFS. Use this to help interpret whether the score change may reflect a meaningful difference over time.

Patient-Reported Function

Mobility or function notes

Optional brief notes about walking, stairs, transfers, or activity limitations.

Assistive device used during assessment

Select any device used during the assessment.

Patient comments

Optional patient-reported context relevant to lower extremity function.

Submission Notes

Consent and disclosure acknowledgement (required)

Required acknowledgement for collection of health-related information.

Yes No N/A

Submitted by

Identify who completed the form if needed for the audit trail.

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