Health-Resiliency-Stress Questionnaire (HRSQ) Provider Registration
HRSQ and all versions: copyrighted, all rights reserved (3/2019)

1) Register in 30-40 seconds and start using the e-HRSQ. This will allow you to receive easy-to-read e-HRSQ responses from your patient/client that are HIPAA-compliant when following the simple guidelines listed below.

2) Create a systematic internal code that is unique and trackable (e.g. patient's MRN or Dr.SmithAS, for Ann Smith who is seeing Dr. Smith that day). Select a designated email of your choice to which responses for the e-HRSQ will be sent (e.g. your work email or a central receptionist email by which the results can be printed or uploaded into an electronic health record, EHR).

3) Provide your patient with the designated email and internal tracking code OR set up patient with an iPad in the waiting room with the designated email and internal tracking code already entered.

4)  Give us feedback on the semi-annual 1 minute survey about clinical utility of the HRSQ. We highly value your input!

1)  Receive by email your patient's completed HRSQ responses; these can be printed, uploaded to an EHR, or both. Also receive relevant supplemental information for you and your client.

2)   Your patient's answers will not be identifiable in any portion of the database. The numeric answers will be pooled with all other data and will become part of a research effort to validate the HRSQ and future studies to better understand the utility of the HRSQ. While completing the e-HRSQ, your client will be prompted to read of this purpose and that it is an approved study through the IRB of the University of Utah; your client will need to provide e-consent directly on the e-HRSQ or can choose not to participate. The pooled database will not be sold, bartered, or shared. No identifying information will be solicited or requested (we won't even know who they are) and the ip address of origin and referral code will be scrubbed and not enter into the database. Just in case a client/patient accidentally enters their name or any potentially identifying information, our database is designed to scrub all unique internal tracking codes. The auto-generated HRSQ responses sent to your designated email will list the internal tracking code that was entered on the e-HRSQ on both the form and in the body of the email. Therefore, it is the responsibility of the provider/clinic to educate their clients/patients to enter the non-identifiable internal tracking code and designated email provided by you/your clinic.

3)    If your patient/client elects to not complete the entirety of the e-HRSQ, the data will not be pooled into the database for research purposes. The incomplete form will still be auto-emailed to you/designated email, as long as your patient/client clicks the submit button at the end of the survey. If the survey is completed but the submit button is not clicked, then the data will not be collected and the auto-email will not be generated.

We thank each of you for using the HRSQ and participating in the validation process. We look forward to helping you to help your patients with more understanding about their health, resilience, and healing from adversity.

The HRSQ is a good-faith effort and has resulted from thousands of hours of donated time and talent by members of the Trauma-Resiliency Collaborative of Utah.

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Name of Work Place
Provider Name *
Type of Workplace *
Type of Healthcare Provider *
Provider State *
Country *
Provider email or general clinic email (e.g. *
How did you hear about the HRSQ project? *
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