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Physical Build
• • •
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Apparent Age
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Dress
• • •
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Dress Comments
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Grooming
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Personal Hygiene
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Grooming/Hygiene Comments
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Interpersonal Style
• • •
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Interpersonal Comments
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Psychomotor Activity
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Psychomotor Comments
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Notable movements?
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Describe Movements
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Speech
• • •
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Speech Comments
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Eye Contact
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Eye Contact Comments
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Add'l Appearance Comments
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Stated Mood (Subjective)
• • •
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Mood Comments
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Affective Range
• • •
|
Range Comments
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Affective Intensity
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Intensity Comments
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Affective Lability
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Lability Comments
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Affective Appropriateness
• • •
|
Appropriateness Comments
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Add'l Mood/Affect Comments
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Folstein Test
|
Folstein Test Score
/
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Folstein: Describe Missed Points
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Person Orientation
|
Person Comments
|
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Place Orientation
|
Place Comments
|
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Time Orientation
|
Time Comments
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Situation
|
Situation Comments
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Add'l Sensorium Comments
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|
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Intellectual Function
|
Intellectual Function Comments
|
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Visuospatial cognition intact?
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Visuospatial Comments
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Abstraction intact?
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Abstraction Comments
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Memory intact?
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Memory Comments
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Executive functions intact?
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Executive Functions Comments
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Intellectual/Cognitive Add'l Com
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Thought process normal?
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Thought Process Comments
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Thought content normal?
|
Thought Content Comments
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Thought Add'l Comments
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