Glasgow Coma Scale — FHIR Questionnaire Template

Eye, verbal and motor responses with the total score (3–15) and its severity band.

Scoring

Eye 1–4, verbal 1–5 and motor 1–6 add up to a total of 3–15: 13–15 mild, 9–12 moderate, 3–8 severe.

Questions

1. Eye opening response
   • No eye opening
   • Eye opening to pain
   • Eye opening to verbal command
   • Eyes open spontaneously
2. Verbal response
   • No verbal response (>2 yrs); no vocal response (<=2 yrs)
   • Incomprehensible sounds
   • Inappropriate words
   • Confused
   • Oriented
3. Motor response
   • No motor response
   • Extension to pain
   • Flexion to pain
   • Withdrawal from pain
   • Localizing pain
   • Obeys commands

Calculated results

• Glasgow Coma Scale total score (3–15)
• Severity

Source and license

Source: Teasdale & Jennett 1974, Lancet 2:81 (Glasgow Coma Scale). Codes and answer lists: LOINC. (link)

License: Original question wording written for this builder; covered by the project license (non-commercial use with attribution; commercial use needs written permission). The scale itself is a published clinical method; see the source. (link)

Provided to save authoring effort, not as medical advice — confirm the scale and its cut-offs for your use case.

Use it

1. Download the FHIR Questionnaire JSON, or
2. open the Builder, choose + Add → From template…, search for “Glasgow Coma Scale” and insert it. It arrives as one titled group with its calculations wired, and you can keep editing it.

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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.