Remote ALS Monitoring & Functional Assessment Form

Remote ALS Monitoring Made Simple with Paperform

Managing amyotrophic lateral sclerosis (ALS) requires consistent monitoring, comprehensive assessments, and coordinated care—all while reducing the burden on patients who face mobility challenges. This Remote ALS Monitoring & Functional Assessment Form is designed specifically for neurology practices, ALS clinics, telehealth providers, and multidisciplinary care teams who need a structured, compassionate way to track disease progression between in-person visits.

Why This Form Matters for ALS Care

ALS is a progressive neurodegenerative disease that affects motor neurons, leading to muscle weakness, respiratory decline, and changes in speech, swallowing, and mobility. Regular monitoring using validated tools like the ALS Functional Rating Scale (ALSFRS-R) is essential for:

• Tracking disease progression over time
• Identifying changes in respiratory or nutritional status early
• Adjusting care plans and introducing assistive technologies at the right time
• Supporting clinical trial eligibility and research participation
• Reducing unnecessary clinic visits while maintaining high-quality care

This Paperform template brings all of these assessments into one easy-to-complete remote form that patients or caregivers can fill out from home, with results flowing directly into your practice management system.

What's Included in This ALS Monitoring Form

This template is built around the core components of comprehensive ALS care:

Patient & Clinical Background: Collects essential demographic information, date of symptom onset, diagnosis date, current medications, and care team details to provide full context for each assessment.

ALS Functional Rating Scale – Revised (ALSFRS-R): Includes all 12 standard domains covering speech, salivation, swallowing, handwriting, cutting food, dressing, turning in bed, walking, climbing stairs, breathing, orthopnea, and respiratory insufficiency. Each question uses the validated 0-4 rating scale, with automatic scoring to track functional decline.

Respiratory Function Assessment: Captures subjective breathing quality, shortness of breath frequency, use of non-invasive ventilation (NIV), and prompts for recent spirometry values (FVC) if available. Early identification of respiratory decline is critical for timely intervention.

Nutritional Status & Swallowing: Evaluates weight changes, dietary modifications, swallowing difficulties, choking episodes, and whether feeding tube placement has been discussed or implemented. Malnutrition and aspiration risk are major concerns in ALS care.

Assistive Technology & Equipment Needs: Identifies current and potential needs for mobility aids (walkers, wheelchairs), communication devices, environmental controls, and home modifications. This helps care coordinators prioritize referrals and funding applications.

Symptom & Quality of Life Check: Includes questions about pain, fatigue, mood, sleep disturbances, and caregiver burden to support holistic, patient-centered care.

Care Plan Updates & Next Steps: Provides space for patients or caregivers to share concerns, ask questions, or request referrals, ensuring the care team has actionable information before the follow-up consultation.

Perfect for Telehealth and Remote Monitoring Programs

With the rise of telehealth, remote ALS monitoring has become not just convenient, but essential. This form can be:

• Sent before virtual visits so clinicians can review functional status and prioritize discussion topics
• Completed at regular intervals (monthly or quarterly) to track progression between appointments
• Shared with multidisciplinary team members including neurologists, respiratory therapists, dietitians, speech-language pathologists, and occupational therapists
• Integrated into care coordination workflows using Paperform's native integrations or Stepper to trigger alerts, schedule follow-ups, or update patient records automatically

By digitizing ALS assessments, you reduce paperwork, improve data accuracy, and give patients and families more autonomy in managing care from home.

Seamless Integration with Your Existing Workflow

Paperform makes it easy to fit this ALS monitoring form into your existing practice systems. You can:

• Embed the form on your patient portal or send it via secure email before telehealth appointments
• Sync submissions to your EHR, CRM, or Google Sheets using native integrations, webhooks, or Stepper workflows
• Set up conditional notifications so that concerning scores (e.g., significant functional decline or new respiratory symptoms) trigger immediate alerts to the care team
• Customize the form to match your clinic's branding, add your logo, and adjust language to fit your patient population

Paperform is SOC 2 Type II compliant and GDPR-ready, ensuring patient data is handled securely. However, please note that Paperform is not a HIPAA-compliant solution, so practices requiring HIPAA compliance should consult with their IT and compliance teams before implementation.

Use Stepper to Automate Post-Submission Care Coordination

Once a patient submits their ALS monitoring form, Stepper (stepper.io) can automate the next steps in their care journey:

• Route high-priority cases to the neurologist or nurse coordinator based on ALSFRS-R score changes
• Schedule follow-up calls or telehealth visits automatically
• Update patient records in your EHR or practice management system
• Trigger referrals to respiratory therapy, nutrition, or assistive technology services when certain thresholds are met
• Send personalized confirmation emails with next steps, educational resources, or appointment reminders

This automation reduces administrative burden and ensures no patient falls through the cracks.

Who This Form Is For

This template is ideal for:

• Neurology practices and ALS clinics managing patients remotely
• Telehealth providers offering virtual ALS care and monitoring
• Multidisciplinary ALS care teams coordinating between specialties
• Research programs and clinical trials requiring standardized functional assessments
• Home health agencies supporting ALS patients and caregivers
• Palliative and hospice care teams tracking quality of life and symptom management

Whether you're a solo neurologist building a telehealth practice or part of a large ALS center, this form gives you a structured, patient-friendly way to monitor disease progression and coordinate care remotely.

Compassionate, Professional, and Easy to Use

Living with ALS is challenging enough—your forms shouldn't add to the burden. This template uses clear, compassionate language, logical question flow, and conditional logic to show only the most relevant questions. Patients and caregivers can complete it in 10-15 minutes from any device, and your team gets structured, actionable data to inform care decisions.

By using Paperform for remote ALS monitoring, you're not just digitizing a form—you're building a more responsive, patient-centered care model that meets people where they are and helps them maintain quality of life as the disease progresses.

Ready to improve your remote ALS care? Customize this template to fit your practice, integrate it with your existing tools, and start gathering better data to support better outcomes. With Paperform's flexibility and Stepper's automation, you can spend less time on paperwork and more time on what matters: caring for your patients.