Custom Python Questionnaire CIF graded concussion symptoms checklist code by Travis Stone
- tstone210
- Jul 13, 2023
- 5 min read
Here is an example of a code for a Questionnaire: Personalization of it for your business is available.

Setting up the kids for a better future than I had.
# -*- coding: utf-8 -*-
"""
Created on Fri Jan 6 14:47:17 2023
"""
#Travis Stone, ATC
correct = True
while correct:
name = input("username:")
if name == "username".lower():
pw = input("password:")
if pw == "password":
print("Enter")
break
if pw != "password":
pwi = input("Wrong, Try Again? y/n")
if pwi == "y".lower():
correct = True
else:
print("bye")
quit()
if name != "username".lower():
uni = input("Wrong, Try Again? y/n")
if uni == "y".lower():
correct == True
else:
print("bye")
quit()
#BMI program
Height = int(input("Enter your Height in cm: "))
Weight = int(input("Enter your Weight in kg: "))
BMI = Weight / (Height/100)**2.
print("Your Body Mass Index (BMI) is: ", BMI)
#BMI classifier low mass, standard mass, high mass, exessive mass, extreme mass
if BMI < 18.5 :
print("low mass", BMI)
if BMI == 18.5-24.9:
print("standard mass", BMI)
if BMI == 25-29.9:
print("high mass", BMI)
if BMI == 30-39.9:
print("excessive mass", BMI)
if BMI > 40:
print("extreme mass", BMI)
#Estimated Maximum Heart-Rate
Age = int(input("Enter your age in years according to the Gregorian Calendar: "))
MaxHeartRate = int(220-Age)
print("Your estimated Maximum Heart-Rate is: ", MaxHeartRate)
#greeting after verification
EyeColor = input("PROTECT YOUR SCREEN VISIBILITY NOW! What is your eye color? Enter it Here: ")
Name = input("Sensitive information viewing expected! What is your legal name? Enter it Here: ")
pw = input("Entering your Password assumes full responsibility for the next screen! What is your current pw? Enter it Here: ")
print(" Welcome, your respective data points are: [Name, Height, Weight, BMI, Age, Maximum Heart-Rate, Eye-Color] ")
#dependent program for Sensitive Information
SensitiveInformation = list[Name, Height, Weight, BMI, Age, MaxHeartRate, EyeColor]
print(SensitiveInformation)
#CIFGradedConcussionSymptomsC @CIFSTATE.ORG cif 052015
#http://www.cifsds.org/uploads/2/3/3/6/23368454/cif_graded_concussion_symptom_checklist.pdf
#Subjective and Objective
DateOfInjury = int(input("When did The Suspected concussion happen:"))
TodaysDate = int(input("Todays Date ddmmyear, no spaces: "))
DiagnosisDate = int(input("Date of Diagnosis or Dr appointment ddmmyear, no spaces: "))
NumberOfConcussions = str(input("What is the Number of concussions you have had in the past:"))
ConcussionClearance = str(input("When were you cleared of your most recent concussion:"))
Birthday = int(input("When were you born ddmmyear, no spaces: "))
Time = str(input("What time is this being taken: "))
Sleep = int(input("How Many Hours of Sleep did you get last night: "))
Name = str(input("What is your legal name: "))
ScoreType = str(input("If this Document is a Baseline Score Type Baseline: If this Document is a Post Concussion Score Type Post Concussion: "))
CapabilityPerception = str(input("Do you feel ready to Return to full activity: "))
Sport = str(input("What activity were you doing when the Head Injury occured: "))
Organization = str(input("What is the name of the organization you are with: "))
PhysicianMD_DO = str(input("Do you understand the injured persons Primary Care Physician needs to sign a release form before return to normal activity TYPE Yes or No: "))
#instructionsA = str(input(print(instructionA, "Note These Symptoms may not all be related to a concussion. Grade the 22+ Symptoms with a score of 0 through 6. "))
#print(instructionsA)
#"You can fill this out at the beginning of the season as a baseline, after a good night's sleep "))
#print(instructionsB)
#i#nstructionsC = str(input("if you suffer a suspected concussion, use this checklist to record your symptoms each day. Be consistent and try to grade either at the beginning or end of each day"))
# print(instructionsC)
# instructionsD = str(input("There is no scale to compare your total score to; this checklist help you follow your symptoms on a day to day basis"))
#print(instructionsD)
#instructionsE = str(input("If your Total Scores are not Decreasing, See Your Physician Right Away"
#print(instructionsE)
#instructionsF = str(input("Show your baseline and daily checks to your physician"))
#print(instructionsF)
#Symptom questions
Headache = int(input("Headache - Zero is nothing 6 Is the worst possible, Rate it 0-6: "))
PreassureWithinHead = int(input("Preassure in your head - Zero is nothing 6 Is the worst possible, Rate it 0-6: "))
NeckPain = int(input("Neck Pain - Zero is nothing 6 Is the worst possible, Rate it 0-6: "))
Nausea = int(input("Nausea - Zero is nothing 6 Is the worst possible, Rate it 0-6: "))
Vomiting = int(input("Vomiting - Zero is nothing 6 Is the worst possible, Rate it 0-6: "))
Dizziness = int(input("Dizziness - Zero is nothing 6 Is the worst possible, Rate it 0-6: "))
BlurredVision = int(input("Blurred Vission - Zero is nothing 6 Is the worst possible, Rate it 0-6: "))
BalanceProblems = int(input("Balance Problems - Zero is nothing 6 Is the worst possible, Rate it 0-6: "))
SensitivityToLight = int(input("Sensitivity to light - Zero is nothing 6 Is the worst possible, Rate it 0-6: "))
SensitivityToNoise = int(input("Sensitivity to noise - Zero is nothing 6 Is the worst possible, Rate it 0-6: "))
FeelingSlowedDown = int(input("Feeling Slowed Down - Zero is nothing 6 Is the worst possible, Rate it 0-6: "))
FeelingLikeWithinaFog = int(input("Feeling like you are in a fog - Zero is nothing 6 Is the worst possible, Rate it 0-6: "))
DontFeelRight = int(input("Dont Feel Right - Zero is nothing 6 Is the worst possible, Rate it 0-6: "))
DifficultyConcentrating = int(input("Difficulty Concentrating - Zero is nothing 6 Is the worst possible, Rate it 0-6: "))
DifficultyRemembering = int(input("Difficulty Remembering - Zero is nothing 6 Is the worst possible, Rate it 0-6: "))
Fatigue = int(input("Fatigue - Zero is nothing 6 Is the worst possible, Rate it 0-6: "))
LowEnergy = int(input("Low Energy - Zero is nothing 6 Is the worst possible, Rate it 0-6: "))
Confusion = int(input("Confusion - Zero is nothing 6 Is the worst possible, Rate it 0-6: "))
Drowsiness = int(input("Drowiness - Zero is nothing 6 Is the worst possible, Rate it 0-6: "))
TroubleFallingAsleep = int(input("Trouble Falling Asleep since the injury - Zero is nothing 6 Is the worst possible Rate it 0-6: "))
MoreEmotionalThanUsual = int(input("Are you more Emotional than usual - Zero is nothing 6 Is the worst possible Rate it 0-6: "))
Irritability = int(input("Irritability - Zero is nothing 6 Is the worst possible Rate it 0-6: "))
Sadness = int(input("Sadness - Zero is nothing 6 Is the worst possible Rate it 0-6: "))
Nervous = int(input("Nervous - Zero is nothing 6 Is the worst possible Rate it 0-6: "))
Anxious = int(input("Anxious - Zero is nothing 6 Is the worst possible Rate it 0-6: "))
print()
print()
TotalSymptomsScore = Headache + PreassureWithinHead + NeckPain + Nausea + Vomiting + Dizziness + BlurredVision + BalanceProblems + SensitivityToLight + SensitivityToNoise + FeelingSlowedDown + FeelingLikeWithinaFog + DontFeelRight + DifficultyConcentrating + DifficultyRemembering + Fatigue + LowEnergy + Confusion + Drowsiness + TroubleFallingAsleep + MoreEmotionalThanUsual + Irritability + Sadness + Nervous + Anxious
Symptoms = 0
while TotalSymptomsScore >= 0:
print("Total Symptoms Score: ", TotalSymptomsScore)
print("This is a ", ScoreType, "Evaluation, On Today's Date & Time: ", TodaysDate, "," , Time )
print("Date Of Injury: ", DateOfInjury)
print("Diagnosis Date: ", DiagnosisDate)
print(CapabilityPerception,", when asked if ready to return to", Sport, "for ", Organization)
print(Name, "has had", NumberOfConcussions, "concussions, and was last cleared", ConcussionClearance)
print("Hours of sleep last night: ", Sleep)
print("Your Body Mass Index (BMI) is: ", BMI)
print("Your estimated maximum Heart-Rate is: ", MaxHeartRate)
print("")
TotalSymptomsScore +=1
break
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