Can the Conners Scale be signed electronically?

Yes. Electronic signatures are legally acceptable under the ESIGN Act (15 U.S.C. ch. 96) and most state UETA laws; confirm institutional policy and any consumer disclosure requirements for healthcare contexts.

Is electronic submission HIPAA-compliant?

It can be if the platform supports required safeguards and a Business Associate Agreement is in place; encryption, access controls, and audit trails are necessary to meet HIPAA obligations.

Who should complete each respondent form?

Use the respondent role specified on the form: parents for home behavior, teachers for school behavior, and self-report for age-appropriate individuals to ensure proper norm-based interpretation.

What happens if a DOB or name is entered incorrectly?

Incorrect identifiers can alter normed scores and create medical record mismatches; correct errors promptly in the chart and document the correction process.

Do I need notarization or witnesses for the form?

Not typically for routine clinical assessments; notarization or witnesses are only needed when required by institutional policy or specific legal authorizations.

How do I correct a submitted Conners Scale?

If an error is found, document the correction in the record, attach the corrected form with a dated note describing the change, and retain the original per your retention policy.

Electronic Signature
Templates
Healthcare
Healthcare Conners Scale

Healthcare Conners Scale

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HEALTHCARE CONNERS SCALE

Purpose: The Conners Scale is a standardized behavioral rating instrument used to assess attention-related symptoms, hyperactivity, impulsivity, and related behavioral concerns. Complete all sections and mark the single response that best describes the individual's behavior over the past month. Responses are confidential and will be used for clinical assessment, treatment planning, and, where authorized, coordination of care.

Patient Information

Patient Name:

Date of Birth: Gender:

Address Primary Phone Emergency Contact

Insurance & Provider

Insurance Provider Policy / Group / Subscriber

Rater / Assessment Information

Rater Name Relationship to Patient Rater Phone

Date of Assessment:

Assessment Setting (check all that apply): Parent/Guardian Teacher Clinician Other

Medical History

Current Medications Allergies Prior Surgeries / Hospitalizations Chronic Conditions

Instructions for Rating

For each statement below, select the one option that best describes the individual's behavior during the past month. Mark only one response per item. Do not leave items blank. If you are unsure, choose the response closest to the overall pattern of behavior.

Behavior Items

Scale: 0 = Not at all, 1 = Just a little, 2 = Pretty much, 3 = Very much

1. Fails to give close attention to details or makes careless mistakes 0 1 2 3

2. Has difficulty sustaining attention 0 1 2 3

3. Does not seem to listen when spoken to directly 0 1 2 3

4. Does not follow through on instructions 0 1 2 3

5. Has difficulty organizing tasks and activities 0 1 2 3

6. Avoids tasks that require sustained mental effort 0 1 2 3

7. Loses things necessary for tasks or activities 0 1 2 3

8. Is easily distracted by extraneous stimuli 0 1 2 3

9. Is forgetful in daily activities 0 1 2 3

10. Fidgets with hands or feet or squirms in seat 0 1 2 3

11. Has difficulty remaining seated 0 1 2 3

12. Runs about or climbs excessively 0 1 2 3

13. Unable to play or engage quietly 0 1 2 3

14. Is "on the go" or acts as if "driven by a motor" 0 1 2 3

15. Talks excessively 0 1 2 3

16. Blurts out answers before questions have been completed 0 1 2 3

17. Has difficulty waiting turn 0 1 2 3

18. Interrupts or intrudes on others 0 1 2 3

19. Is irritable or has frequent temper outbursts 0 1 2 3

20. Exhibits sudden mood changes 0 1 2 3

21. Lower academic performance than expected 0 1 2 3

22. Difficulty sustaining effort on tasks requiring concentration 0 1 2 3

23. Often argues with adults 0 1 2 3

24. Deliberately annoys others 0 1 2 3

25. Exhibits impulsive decision-making that causes risk 0 1 2 3

Clinician Notes & Interpretation

Clinician Observations / Interpretation Assessment Completed By (Clinician Name and Credentials)

Confidentiality & Authorization

Information recorded on this scale and associated clinical records are protected health information. Results will be disclosed only for treatment, payment, or health care operations, or as otherwise authorized by law or by the patient/guardian. By checking the acknowledgement box below, the rater certifies that the information provided is accurate to the best of their knowledge and authorizes the use of the assessment for clinical evaluation and treatment planning.

I acknowledge the above confidentiality statement and certify the accuracy of my responses.

Authorization to share assessment results with third parties (optional): Authorize sharing results

If authorized, expiration date for this authorization:

Scoring Note

Scoring: Raw item scores should be summed within relevant subscales and converted to standardized scores per the instrument manual. Elevated subscale or total scores indicate increased frequency/intensity of symptoms and should prompt comprehensive clinical evaluation. Scores and notes are clinical data; for formal diagnosis, integrate with developmental history, clinician interview, and other sources of information.

Printed Name:

Relationship:

Signature:

Date:

What the Healthcare Conners Scale Is and how it’s used

The Healthcare Conners Scale is a standardized behavioral rating instrument used in clinical settings to assess attention, hyperactivity, and related behavioral concerns across age-appropriate versions. Clinicians, educators, parents, and the patient (when age-appropriate) provide item-level ratings that produce scaled scores and percentile interpretations. Scores inform diagnostic impressions, monitor treatment response, and support care planning together with clinical interviews and objective testing. Because responses often contain protected health information, clinical use should align with applicable privacy and recordkeeping rules, including HIPAA and institutional policies.

Why clinicians and practices rely on the Healthcare Conners Scale

The Conners Scale gives objective, norm-referenced symptom measurement that complements clinical interview and observation to support accurate assessment and tracking.

Typical users and roles for the Healthcare Conners Scale

The scale is completed by multiple respondent types depending on clinical context and patient age.

Pediatricians and child psychiatrists providing diagnostic evaluations and monitoring treatment outcomes.
School psychologists or educators contributing teacher-report forms for multi-informant assessment.
Parents or caregivers completing observer-report forms for home-based symptom measurement.

Responses are combined with clinician scoring and interpretation for diagnostic and treatment records.

Quick step-by-step: complete and route a Conners Scale

Follow a simple sequence to collect responses, score, review, and add to the patient record.

01

Prepare form: Select correct version and respondent type.
02

Collect responses: Have respondent complete all items accurately.
03

Score items: Apply scoring rules or automated calculator.
04

File record: Attach report to the medical record and document reviewer.

Digital workflow settings to support Conners Scale use

Common platform settings help ensure secure collection, scoring, and storage while preserving audit history.

Field	Configuration
Upload format	PDF or DOCX; ensure fillable PDF for automated parsing
Authentication	Email link or SMS code for respondent identity verification
Scoring	Use validated scoring tool or manual calculation with documented method
Notifications	Alert clinician on completion via EHR or secure email

How electronic completion and submission typically flow

Electronic workflows reduce turnaround and preserve a detailed audit trail for each completed scale.

Send form: Sender emails secure link to the respondent.
Respondent signs: Respondent completes items and submits securely.
Review by clinician: Clinician scores and records interpretation.
Store securely: Final report saved to EHR or secure storage.

Technical and platform considerations for eSubmission

Ensure the chosen platform supports secure upload, audit trails, and integration with clinical systems.

File formats: Accepts PDF, DOCX for interoperability
Integrations: Integrates with EHR, Google Drive, Box, NetSuite
Authentication: Supports email, SMS code, and advanced methods

Configure retention, access controls, and BAAs where required; verify interoperability with your EHR before deployment.

Security and compliance features to expect

Encryption: TLS 1.2/1.3 in transit; AES-256 at rest

HIPAA: BAA required to process PHI

Audit Trail: Complete timestamped signing history

Access Controls: Role-based permissions and logging

Authentication: Email, SMS, KBA, or advanced options

Certifications: SOC 2 Type II and ISO 27001

Common preparation and submission pitfalls to avoid

Incomplete respondent information or wrong respondent type leading to invalid scoring and interpretation.
Missing or inconsistent DOB entries causing incorrect age-normed conversions and percentile errors.
Failing to obtain documented consent or authorization when required for minors or protected contexts.
Storing signed forms in unsecured email or shared drives without access controls, risking privacy violations.

Key legal and clinical risks from incorrect or mishandled forms

HIPAA violations: Civil and criminal penalties possible

Billing denials: Incomplete documentation can trigger denials

Misdiagnosis risk: Faulty data may lead to wrong treatment

Invalid consent: Missing consent undermines legality

Evidence exclusion: Poor records weaken legal defensibility

Data breach costs: Notification and remediation expenses

Core components of a professional Healthcare Conners Scale package

A complete package includes validated items, clear respondent instructions, scoring tools, and exportable reports for clinical documentation.

Validated items

Norm-referenced questions derived from the Conners family of assessments with established psychometric properties for target age groups.

Multiple versions

Parent-, teacher-, and self-report forms plus age-specific versions to support multi-informant assessment across childhood and adolescence.

Scoring algorithm

Standardized scoring produces T-scores or percentiles and flags clinically significant elevations for clinician review.

Interpretive report

Automated or manual narrative summaries that translate numeric scores into clinical impressions and recommended next steps.

Administrative fields

Patient identifiers, dates, respondent role, and clinician notes included for billing and legal documentation.

Export options

Printable PDF and machine-readable exports for EHR import and interdisciplinary sharing.

Format and delivery features that improve clinical utility

Select tools offering flexible formats, accessibility features, and reporting that fit clinical and administrative workflows.

Formats Supported

Fillable PDF and DOCX for on-screen completion; machine-readable exports (CSV, JSON) for integration with scoring systems and EHRs.

Scoring Options

Automated scoring with audit log or manual scoring with documented method; both preserve traceability for audits and billing.

Report Exports

Secure PDF with embedded audit trail and clinician interpretation, suitable for inclusion in the legal medical record.

Accessibility

Keyboard and screen-reader compatibility (WCAG Level AA) and adjustable fonts for patient accessibility.

Practical tips for accurate and efficient completion

Implementing consistent intake and scoring processes reduces errors and speeds clinical decision-making.

Standardize intake procedures

Use the same respondent definitions and versions across patients. Train staff on respondent selection and completion rules to minimize scoring variance and administrative rework.

Validate identity

Confirm respondent identity when feasible using email or SMS verification. This helps ensure attribution and supports auditability required under ESIGN and institutional policies.

Use automated scoring

Automated calculators reduce transcription errors. Always review flagged elevations manually and document clinical interpretation in notes.

Document consent

Capture signed consent or authorization for assessment and data sharing, noting the method used and keeping a dated copy in the chart.

Illustrative use cases for the Healthcare Conners Scale in clinical practice

Two representative scenarios show how the scale supports assessment, documentation, and treatment planning across settings.

Pediatric Clinic Evaluation

A primary care clinic screens children presenting with attention concerns using parent and teacher Conners forms

Multi-informant scores identify target symptoms
Clinician documents baseline, initiates behavioral plan, and repeats scale at follow-up to track response and adjust care.

School-Based Assessment

A school psychologist collects teacher and parent Conners reports as part of an educational evaluation

Results support eligibility and intervention planning
The school stores completed forms in the restricted student record and shares summaries with the multidisciplinary team under parental consent.

Timing considerations and typical processing expectations

Establish clear timelines for completion, clinician review, and documentation to support clinical and administrative requirements.

Initial assessment timing:

Complete baseline Conners Scale at intake or prior to the diagnostic visit.

Follow-up intervals:

Repeat at clinically indicated intervals to monitor treatment response, commonly 4–12 weeks.

Clinician review window:

Review completed forms within 7 business days for timely clinical action.

Billing documentation:

Ensure scored report and clinician note accompany any billed evaluation services.

Record update:

Upload final report to the chart immediately after clinician sign-off.

Key milestones in the Conners Scale lifecycle

A sequential milestone view helps teams track assessment progress from request to long-term storage.

01

Assessment Requested

Clinician or school requests form completion from respondent.

02

Form Completed

Respondent submits the completed scale electronically or on paper.

03

Clinician Review

Clinician scores, interprets, and documents findings.

04

Record Retention

Final report is stored per retention schedule and access policies.

Notarization, witness, and identity steps when additional authentication is required

Some institutional policies may require enhanced identity verification, notarization, or witness signatures for specific authorizations.

01

Determine requirement

Confirm if organization or payer demands notarization or witness.

02

Select method

Choose in-person notary, RON, or verified e-sign based on policy.

03

Identity proofing

Use ID credential analysis and multi-factor authentication where required.

04

Record audio-video

RON requires recording retention by many states for the notarial act.

05

Retain journal

Notary journal entries should be stored per state requirements.

06

Attach certificate

Include notarization or witness certificate with the signed form.

07

Verify acceptance

Confirm receiving party will accept the chosen authentication method.

08

Update policy

Document the process for future consistency and audit readiness.

Selected eSignature vendor comparison for Conners Scale workflows

Compare basic pricing and key compliance attributes across vendors. signNow is listed first per page convention; verify vendor plans for the latest details.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/month billed annually (Business plan)	$15/user/month billed annually (DocuSign)	$14/user/month billed annually (Adobe Sign)	$19/user/month billed annually (PandaDoc)	$15/user/month billed annually (HelloSign)
Free Trial	7-day free trial, no credit card required	Varies by vendor and plan; verify	Varies by vendor and plan; verify	Varies by vendor and plan; verify	Varies by vendor and plan; verify
Bulk Send	Bulk send included on Business Premium plan	Bulk send available on select paid plans	Bulk send available on paid plans	Bulk send available on enterprise plans	Bulk send limited; verify plan
Audit Trail	Comprehensive audit trail included for all transactions	Comprehensive audit trail included	Comprehensive audit trail included	Comprehensive audit trail included	Comprehensive audit trail included
HIPAA Compliant	HIPAA-compliant; BAA available upon request	HIPAA-compliant; BAA available upon request	HIPAA-compliant; BAA available upon request	No HIPAA BAA broadly offered	No HIPAA BAA broadly offered
Envelope Cap	No envelope cap on paid plans	Limit: 100 envelopes per user per year	Limits vary by plan; verify	Limits vary by plan; verify	Limits vary by plan; verify

Frequently asked questions about using and submitting the Healthcare Conners Scale

Answers focus on common legal, technical, and clinical questions encountered when collecting and storing Conners Scale data electronically.

Need help? Contact support

Can the Conners Scale be signed electronically?
Yes. Electronic signatures are legally acceptable under the ESIGN Act (15 U.S.C. ch. 96) and most state UETA laws; confirm institutional policy and any consumer disclosure requirements for healthcare contexts.
Is electronic submission HIPAA-compliant?
It can be if the platform supports required safeguards and a Business Associate Agreement is in place; encryption, access controls, and audit trails are necessary to meet HIPAA obligations.
Who should complete each respondent form?
Use the respondent role specified on the form: parents for home behavior, teachers for school behavior, and self-report for age-appropriate individuals to ensure proper norm-based interpretation.
What happens if a DOB or name is entered incorrectly?
Incorrect identifiers can alter normed scores and create medical record mismatches; correct errors promptly in the chart and document the correction process.
Do I need notarization or witnesses for the form?
Not typically for routine clinical assessments; notarization or witnesses are only needed when required by institutional policy or specific legal authorizations.
How do I correct a submitted Conners Scale?
If an error is found, document the correction in the record, attach the corrected form with a dated note describing the change, and retain the original per your retention policy.

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