Ready-made FHIR Questionnaire Templates: Screening Scales, Calculators and Intake
Standard screening scales are widely used, but turning one into a correct FHIR Questionnaire — the exact wording, LOINC-coded questions and answers, the scores and a working total — takes care. The FHIR Questionnaire Builder ships ready-made templates you can insert in one click and keep editing.
How it works
- In the Builder, choose + Add → From template… (or Insert template… in any group's or item's ⚙ menu).
- Search the list, check the source and license, and insert the template.
- It arrives as one titled group with its calculations already wired. If an id would clash with your questionnaire, the builder renames it for you, calculations included.
Templates keep the published wording of each scale and credit their authors. They are provided to save authoring effort, not as medical advice — confirm a scale and its cut-offs for your use case.
Templates
PHQ-9 Depression Screening
Nine-question depression screener with an automatic total score and severity band (minimal to severe).
Scoring: Each answer scores 0–3. The total (0–27) maps to minimal (0–4), mild (5–9), moderate (10–14), moderately severe (15–19) or severe (20–27) depression.
Questions
- Little interest or pleasure in doing things
- Feeling down, depressed, or hopeless
- Trouble falling or staying asleep, or sleeping too much
- Feeling tired or having little energy
- Poor appetite or overeating
- Feeling bad about yourself — or that you are a failure or have let yourself or your family down
- Trouble concentrating on things, such as reading the newspaper or watching television
- Moving or speaking so slowly that other people could have noticed? Or the opposite — being so fidgety or restless that you have been moving around a lot more than usual
- Thoughts that you would be better off dead, or of hurting yourself in some way
- If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?
Source: Kroenke, Spitzer & Williams 2001, J Gen Intern Med 16:606 (PHQ-9). Codes: LOINC; form text as published at phqscreeners.com. (link)
License: Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc. No permission required to reproduce, translate, display or distribute. (link)
GAD-7 Anxiety Screening
Seven-question generalized anxiety screener with an automatic total score and severity band (minimal to severe).
Scoring: Each answer scores 0–3. The total (0–21) maps to minimal (0–4), mild (5–9), moderate (10–14) or severe (15–21) anxiety.
Questions
- Feeling nervous, anxious or on edge
- Not being able to stop or control worrying
- Worrying too much about different things
- Trouble relaxing
- Being so restless that it is hard to sit still
- Becoming easily annoyed or irritable
- Feeling afraid as if something awful might happen
Source: Spitzer et al. 2006, Arch Intern Med 166:1092 (GAD-7). Codes: LOINC; form text as published at phqscreeners.com. (link)
License: Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc. No permission required to reproduce, translate, display or distribute. (link)
AUDIT-C Alcohol Use Screening
Three-question alcohol consumption screen with an automatic total score (0–12) and the usual positive-screen thresholds.
Scoring: Each answer scores 0–4. The total (0–12) is a positive screen at 4 or more for men and 3 or more for women.
Questions
- How often do you have a drink containing alcohol?
- How many standard drinks containing alcohol do you have on a typical day?
- How often do you have 6 or more drinks on 1 occasion?
Source: Bush et al. 1998, Arch Intern Med 158:1789 (AUDIT-C, from the WHO AUDIT). Codes and answer lists: LOINC, as in the HL7 US Core AUDIT-C questionnaire. (link)
License: No restrictions on use (per the ONC USCDI/ISP listing; submitted by NIAAA). (link)
PHQ-2 Depression Screening
Two-question depression screener with an automatic total and positive-screen flag; the short entry to the PHQ-9.
Scoring: Each answer scores 0–3. The total (0–6) is a positive screen at 3 or more.
Questions
- Little interest or pleasure in doing things
- Feeling down, depressed, or hopeless
Source: Kroenke, Spitzer & Williams 2003, Med Care 41:1284 (PHQ-2). Codes: LOINC; form text as published at phqscreeners.com. (link)
License: Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc. No permission required to reproduce, translate, display or distribute. (link)
GAD-2 Anxiety Screening
Two-question anxiety screener with an automatic total and positive-screen flag; the short entry to the GAD-7.
Scoring: Each answer scores 0–3. The total (0–6) is a positive screen at 3 or more.
Questions
- Feeling nervous, anxious or on edge
- Not being able to stop or control worrying
Source: Kroenke et al. 2007, Ann Intern Med 146:317 (GAD-2). Codes: LOINC; form text as published at phqscreeners.com. (link)
License: Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc. No permission required to reproduce, translate, display or distribute. (link)
Patient Demographics
Name, date of birth, sex assigned at birth and contact details for a patient intake form.
Scoring: No scoring — a data-collection fragment.
Questions
- First name
- Last name
- Date of birth
- Sex assigned at birth
- Phone number
- Email address
- Home address
Source: Original wording written for this builder.
License: Original wording written for this builder; covered by the project license (non-commercial use with attribution; commercial use needs written permission). (link)
Allergies
'No known allergies' plus a repeatable list of allergens with reaction and severity.
Scoring: No scoring — a data-collection fragment.
Questions
- No known allergies
- Allergy
Source: Original wording written for this builder.
License: Original wording written for this builder; covered by the project license (non-commercial use with attribution; commercial use needs written permission). (link)
Current Medications
'Not taking any medications' plus a repeatable list with dose, frequency and reason.
Scoring: No scoring — a data-collection fragment.
Questions
- Not taking any medications
- Medication
Source: Original wording written for this builder.
License: Original wording written for this builder; covered by the project license (non-commercial use with attribution; commercial use needs written permission). (link)
Pain Assessment
Pain severity on a 0–10 scale, location, onset and a free-text description.
Scoring: No scoring — severity is recorded as a 0–10 number.
Questions
- Pain severity right now (0 = no pain, 10 = worst pain imaginable)
- Where is the pain?
- When did the pain start?
- Describe the pain (for example sharp, dull or burning)
Source: Original wording written for this builder.
License: Original wording written for this builder; covered by the project license (non-commercial use with attribution; commercial use needs written permission). (link)
Body Measurements
Height, weight, sex and waist/hip with BMI (and its WHO category), body surface area, ideal body weight and waist-to-hip ratio.
Scoring: Calculated values only; each result stays empty until all of its inputs are answered.
Questions
- Height (cm)
- Weight (kg)
- Sex assigned at birth (used by the ideal body weight formula)
- Waist circumference (cm)
- Hip circumference (cm)
Source: Quetelet index (weight kg ÷ height m²); WHO adult BMI classification; Mosteller 1987, N Engl J Med 317:1098; Devine 1974, Drug Intell Clin Pharm 8:650; WHO Expert Consultation 2008, Waist circumference and waist–hip ratio (Geneva). Codes: LOINC.
License: Original wording written for this builder; covered by the project license (non-commercial use with attribution; commercial use needs written permission). Formulas are published methods; see the source. (link)
Kidney Function
Creatinine, age, sex and weight with eGFR (CKD-EPI 2021) and creatinine clearance (Cockcroft–Gault).
Scoring: Calculated values only; each result stays empty until all of its inputs are answered.
Questions
- Age (years)
- Sex assigned at birth (used by both formulas)
- Weight (kg)
- Serum creatinine (mg/dL)
Source: Inker et al. 2021, N Engl J Med 385:1737 (race-free CKD-EPI); Cockcroft & Gault 1976, Nephron 16:31. Codes: LOINC.
License: Original wording written for this builder; covered by the project license (non-commercial use with attribution; commercial use needs written permission). Formulas are published methods; see the source. (link)
Cardiac Measurements
Blood pressure, QT interval and heart rate with mean arterial pressure and corrected QT (Bazett and Fridericia).
Scoring: Calculated values only; each result stays empty until all of its inputs are answered.
Questions
- Systolic blood pressure (mmHg)
- Diastolic blood pressure (mmHg)
- QT interval (ms)
- Heart rate (beats per minute)
Source: Standard estimate: (systolic + 2 × diastolic) ÷ 3; Bazett 1920; Fridericia 1920. Codes: LOINC.
License: Original wording written for this builder; covered by the project license (non-commercial use with attribution; commercial use needs written permission). Formulas are published methods; see the source. (link)
Lipid Panel
Total cholesterol, HDL and triglycerides with calculated LDL cholesterol (Friedewald).
Scoring: Calculated values only; each result stays empty until all of its inputs are answered.
Questions
- Total cholesterol (mg/dL)
- HDL cholesterol (mg/dL)
- Triglycerides (mg/dL)
Source: Friedewald et al. 1972, Clin Chem 18:499. Codes: LOINC.
License: Original wording written for this builder; covered by the project license (non-commercial use with attribution; commercial use needs written permission). Formulas are published methods; see the source. (link)
Chemistry Calculations
Electrolytes, calcium, albumin, glucose and insulin with anion gap, albumin-corrected calcium and HOMA-IR.
Scoring: Calculated values only; each result stays empty until all of its inputs are answered.
Questions
- Sodium (mmol/L)
- Chloride (mmol/L)
- Bicarbonate (mmol/L)
- Total calcium (mg/dL)
- Albumin (g/dL)
- Fasting glucose (mg/dL)
- Fasting insulin (µU/mL)
Source: Standard potassium-free form: Na − (Cl + HCO₃); Payne et al. 1973, BMJ 4:643; Matthews et al. 1985, Diabetologia 28:412. Codes: LOINC.
License: Original wording written for this builder; covered by the project license (non-commercial use with attribution; commercial use needs written permission). Formulas are published methods; see the source. (link)
FIB-4 Liver Fibrosis Index
Age, AST, ALT and platelets with the FIB-4 index and its fibrosis-risk category.
Scoring: Calculated values only; each result stays empty until all of its inputs are answered.
Questions
- Age (years)
- AST (U/L)
- ALT (U/L)
- Platelets (×10⁹/L)
Source: Shah et al. 2009, Clin Gastroenterol Hepatol 7:1104 (cut-offs 1.3 / 2.67). Codes: LOINC.
License: Original wording written for this builder; covered by the project license (non-commercial use with attribution; commercial use needs written permission). Formulas are published methods; see the source. (link)
Pregnancy Dating
Last menstrual period and visit date with the expected delivery date (Naegele) and gestational age in weeks.
Scoring: Calculated values only; each result stays empty until all of its inputs are answered.
Questions
- First day of last menstrual period
- Visit date
Source: Naegele's rule, 280-day form (regular 28-day cycle); Standard LMP dating (completed weeks since the first day of the last period). Codes: LOINC.
License: Original wording written for this builder; covered by the project license (non-commercial use with attribution; commercial use needs written permission). Formulas are published methods; see the source. (link)
This material contains content from LOINC (loinc.org). LOINC is copyright © Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee and is available at no cost under the LOINC license.