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Ready-made questionnaire templates you can insert into your own questionnaire.

qSOFA Sepsis Screen — FHIR Questionnaire Template

Three bedside yes/no criteria with the qSOFA score and its risk result; two or more criteria mean a high risk of poor outcome.

Scoring

Each criterion that is present scores 1 point. An unanswered criterion counts as No; the result appears once at least one criterion is answered.

Questions

  1. Respiratory rate 22 breaths per minute or higher
  2. Altered mentation (Glasgow Coma Scale below 15)
  3. Systolic blood pressure 100 mmHg or lower

Calculated results

Source and license

Source: Singer et al. 2016 (Sepsis-3), JAMA 315:801. (link)

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)

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 “qSOFA Sepsis Screen” and insert it. It arrives as one titled group with its calculations wired, and you can keep editing it.

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