Patient Assessment Template | Ambulatory Severity Index

The Ambulatory Severity Index is a method to better quantitate the total complexity of an ambulatory visit.

NOTE: The exact details of the index are sketchy in the original article (Horn et al, 1988). I hope to find additional references to clarify this.

Diagnoses and Problems

All diagnoses and problems addressed at the visit are graded based on their seriousness.

Level	Severity	Implication
1	none or mild	warrants no intervention
2	moderate	action may be taken
3	severe	requires workup (and resource utilization)
4	catastrophic	consider hospital admission

Each item of level 2 or higher is squared, giving greater weight to items which are more serious.

Complexity Factors

Biological and biophysical factors

(1) urgency

(2) complications

Behavioral factors

(3) social situation

(4) physical functioning

(5) psychological functioning

(6) compliance

(7) communication

Functioning	Level
normal	1
problems but not interfering with implementation of treatment	2
problems interfering with implementation of treatment	3
lack of ability to function independently	4

Score

The final score is given as a single number called the S^4 score (the signs and symbols, sum of squares).

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Ambulatory Severity Index (ASI)