5 steps · 15–20 minutes. Results copy directly to clipboard for Practice Fusion or any EMR. All fields are de-identified before entering the IRB registry.
1
Demographics
2
Medical Hx
3
Symptoms
4
Labs / Goals
5
Review
Step 1 of 5 — Demographics
Demographics
Basic patient information. Initials only — de-identified for the research registry.
Step 1 of 5
Medical History
Current conditions, medications, allergies, and surgical history.
Step 2 of 5
Symptom Assessment
Rate each axis 0–10. 0 = not present. 10 = severe, daily, significantly affecting quality of life.
0 = excellent sleep · 10 = severe insomnia every night
NoneModerateSevere
Pain / Musculoskeletal0
0 = no pain · 10 = constant severe pain limiting all activity
NoneModerateSevere
Mood / Anxiety / Depression0
0 = stable, positive mood · 10 = severe anxiety or depression daily
NoneModerateSevere
Libido / Sexual Function0
0 = no concerns · 10 = complete loss of libido or sexual dysfunction
NoneModerateSevere
GI / Digestive0
0 = no GI symptoms · 10 = severe daily bloating, pain, or diarrhea
NoneModerateSevere
Body Composition0
0 = satisfied · 10 = significantly overweight or underweight, major concern
NoneModerateSevere
Skin / Hair / Cosmetic0
0 = no concerns · 10 = significant concerns about aging, hair loss, or appearance
NoneModerateSevere
Step 3 of 5
Labs & Clinical Goals
Paste lab values and define goals. SHERPA generates protocol recommendations directly from this data.
Step 4 of 5
Review & Copy
Your intake summary is ready. Copy to clipboard for Practice Fusion, your EMR, or paste directly into SHERPA.
📋 Practice Fusion / EMR — Copy Ready
Complete steps 1–4 to generate your patient summary here.
Step 5 of 5
✓
Intake complete.
Patient enrolled in PPRN-001-2025. Data is de-identified and logged in the IRB outcomes registry. Your copied summary is ready to paste into your EMR. Next: run labs through SHERPA for protocol recommendations.