ladill-care/database/data/assessments/morse.v1.json

{
  "template": {
    "code": "morse",
    "name": "Morse Fall Scale",
    "category": "screening",
    "version": 1,
    "is_current": true,
    "is_active": true,
    "scoring_strategy": "sum_items",
    "description": "Morse Fall Scale for inpatient fall risk. Higher scores = higher risk (0–125).",
    "meta": {
      "capture_roles": ["nurse", "ed_nurse", "theatre_nurse", "labour_ward_nurse", "fertility_nurse", "dialysis_nurse", "midwife", "doctor", "general_physician"],
      "specialty": "nursing",
      "pack_family": "nursing",
      "estimated_minutes": 3,
      "max_total": 125,
      "severity_bands": [
        { "max": 24, "label": "Low risk" },
        { "max": 44, "label": "Medium risk" },
        { "max": 125, "label": "High risk" }
      ],
      "attribution": "Morse Fall Scale — verify licensing for commercial redistribution of branded materials."
    }
  },
  "questions": [
    {
      "code": "history_falling",
      "section": "Fall risk",
      "label": "History of falling",
      "answer_type": "score_item",
      "is_required": true,
      "sort_order": 10,
      "score_key": "morse",
      "options": {
        "max": 25,
        "choices": [
          { "code": "0", "label": "No", "score": 0 },
          { "code": "25", "label": "Yes", "score": 25 }
        ]
      }
    },
    {
      "code": "secondary_diagnosis",
      "section": "Fall risk",
      "label": "Secondary diagnosis",
      "answer_type": "score_item",
      "is_required": true,
      "sort_order": 20,
      "score_key": "morse",
      "options": {
        "max": 15,
        "choices": [
          { "code": "0", "label": "No", "score": 0 },
          { "code": "15", "label": "Yes", "score": 15 }
        ]
      }
    },
    {
      "code": "ambulatory_aid",
      "section": "Fall risk",
      "label": "Ambulatory aid",
      "answer_type": "score_item",
      "is_required": true,
      "sort_order": 30,
      "score_key": "morse",
      "options": {
        "max": 30,
        "choices": [
          { "code": "0", "label": "None / bed rest / nurse assist", "score": 0 },
          { "code": "15", "label": "Crutches / cane / walker", "score": 15 },
          { "code": "30", "label": "Furniture", "score": 30 }
        ]
      }
    },
    {
      "code": "iv_therapy",
      "section": "Fall risk",
      "label": "IV / heparin lock",
      "answer_type": "score_item",
      "is_required": true,
      "sort_order": 40,
      "score_key": "morse",
      "options": {
        "max": 20,
        "choices": [
          { "code": "0", "label": "No", "score": 0 },
          { "code": "20", "label": "Yes", "score": 20 }
        ]
      }
    },
    {
      "code": "gait",
      "section": "Fall risk",
      "label": "Gait / transferring",
      "answer_type": "score_item",
      "is_required": true,
      "sort_order": 50,
      "score_key": "morse",
      "options": {
        "max": 20,
        "choices": [
          { "code": "0", "label": "Normal / bedrest / immobile", "score": 0 },
          { "code": "10", "label": "Weak", "score": 10 },
          { "code": "20", "label": "Impaired", "score": 20 }
        ]
      }
    },
    {
      "code": "mental_status",
      "section": "Fall risk",
      "label": "Mental status",
      "answer_type": "score_item",
      "is_required": true,
      "sort_order": 60,
      "score_key": "morse",
      "options": {
        "max": 15,
        "choices": [
          { "code": "0", "label": "Oriented to own ability", "score": 0 },
          { "code": "15", "label": "Forgets limitations", "score": 15 }
        ]
      }
    }
  ]
}