Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) Screening & Assessment Form

Streamline CIDP Screening with a Professional Assessment Form

Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) is a rare neurological disorder that requires careful screening and assessment. Our CIDP Screening & Assessment Form helps healthcare providers, neurologists, and medical practices systematically evaluate patients for suspected CIDP, document progressive weakness patterns, review nerve conduction study criteria, and determine appropriate neurology referral pathways.

Why Healthcare Providers Choose This CIDP Screening Template

Diagnosing CIDP can be complex, requiring detailed patient history, neurological examination findings, and correlation with electrodiagnostic studies. This form template provides a structured approach to:

• Capture comprehensive symptom history including onset, progression, and distribution of weakness
• Document clinical examination findings systematically to track disease progression
• Screen for EFNS/PNS diagnostic criteria for CIDP to support clinical decision-making
• Evaluate nerve conduction study results and demyelinating features
• Determine urgency and appropriateness of neurology or neuromuscular specialist referral
• Maintain organized patient records for longitudinal monitoring and treatment planning

Built for Modern Healthcare Workflows

Whether you're a primary care physician screening for peripheral neuropathy, a neurologist managing a neuromuscular clinic, or a healthcare administrator coordinating specialist referrals, this Paperform template integrates seamlessly into your existing workflows.

The form's conditional logic automatically adapts based on patient responses—if red flag symptoms are identified, additional assessment sections appear, and referral pathways are prioritized. This intelligent branching ensures comprehensive data collection while maintaining efficiency in busy clinical settings.

Connect your healthcare systems: Paperform integrates with your existing EHR, practice management software, and communication tools. Use Stepper (stepper.io) to automatically route completed assessments to neurology departments, schedule follow-up appointments, send patient education materials, and update clinical databases—all without manual data entry.

Professional Design That Builds Patient Confidence

First impressions matter in healthcare. This template uses Paperform's document-style editor to create a clean, professional assessment form that patients and referring providers trust. Customize fonts, colors, and branding to match your practice identity, whether you're a hospital system, private neurology practice, or specialty clinic.

The multi-page layout organizes complex medical information into logical sections, reducing cognitive load and improving completion rates. Guided mode is available for patient-facing versions, creating a conversational experience that gathers sensitive health information with empathy.

CIDP-Specific Features for Accurate Assessment

This template includes specialized sections for CIDP evaluation:

• Symptom onset and progression tracking (acute vs. subacute vs. chronic)
• Weakness distribution assessment (proximal vs. distal, symmetric patterns)
• Sensory symptom documentation (paresthesias, numbness, proprioception loss)
• Functional impact evaluation (ambulatory status, fine motor skills, ADL limitations)
• Nerve conduction study findings checklist (demyelinating features, conduction blocks, temporal dispersion)
• Treatment history review (response to immunotherapy, previous diagnoses)
• Differential diagnosis screening (excluding GBS, POEMS, paraproteinemic neuropathies)

Secure, Compliant Data Management

Healthcare data security is non-negotiable. Paperform is SOC 2 Type II compliant and offers robust security features including data encryption, role-based access controls, and detailed audit trails. Store sensitive patient information with confidence, knowing your CIDP screening data is protected to enterprise standards.

Please note: While Paperform provides enterprise-grade security features, it is not HIPAA compliant. Healthcare organizations requiring HIPAA compliance should review their specific regulatory requirements and consult with their compliance team.

Perfect for Multiple Healthcare Settings

This CIDP screening template serves various healthcare contexts:

• Primary care practices screening patients with unexplained weakness or neuropathy symptoms
• Neurology clinics conducting comprehensive neuromuscular assessments
• Hospital neurology departments triaging referrals and prioritizing urgent cases
• Rehabilitation centers assessing functional capacity and therapy needs
• Research institutions standardizing CIDP phenotype documentation for clinical studies
• Telemedicine providers conducting remote neurological assessments

Automation That Saves Clinical Time

Reduce administrative burden with intelligent automation. When a screening suggests probable CIDP, Stepper can automatically:

• Generate a referral letter with key clinical findings pre-populated
• Schedule nerve conduction studies with electromyography departments
• Send patient education materials about CIDP and what to expect
• Alert neurology intake coordinators for expedited scheduling
• Create follow-up reminders for progressive symptom monitoring
• Update patient registries or quality improvement databases

Get Started in Minutes

No coding or technical expertise required. Simply customize this template with your practice information, adjust clinical criteria to match your institutional protocols, and embed the form on your patient portal, share via secure link, or integrate into your referral management system.

With Paperform's intuitive interface, your clinical team can make updates on the fly—add new assessment scales, modify referral criteria, or update specialist contact information—all without waiting on IT support.

Trusted by Healthcare Providers Worldwide

Join over 500,000 teams using Paperform to modernize their healthcare workflows. Our platform combines the flexibility of custom forms with the reliability and security that medical practices demand.

Ready to improve your CIDP screening process? Start with this professionally designed template and deliver faster, more accurate assessments that lead to earlier diagnosis and better patient outcomes.