.|.|The Saint Louis University Mental Status Examination||Date Given: <.Date_Given.>|Clinician: <.Staff_Ordered_By.>|Location: <.Location.>||Veteran: <.Patient_Name_Last_First.>|SSN:
results should be verified for accuracy and used in conjunction with other diagnostic activities and procedures.||Copyright (c) 2003 Saint Louis University| $~
<.Patient_SSN.>|DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)|Gender: <.Patient_Gender.>||SLUMS Score: <-Total Score->||High school education | 27-30 Normal| 21-26 Mild
Neurocognitive Disorder| 1-20 Dementia ||Less than High School| 25-30 Normal| 20-24 Mild Neurocognitive Disorder| 1-19 Dementia|||Questions and Answers||A. Is the patient alert?|
<*Answer_4940*>|B. Level of education:| <*Answer_4951*>|1. What day of the week is it?| <*Answer_5083*>|2. What is the year?| <*Answer_5092*>|3. What state are we in?| <*Answer_5093*>|4.
Please remember these five objects. I will ask you what they are later. Apple Pen Tie House Car| <*Answer_5338*>|5A. How much did you spend?| <*Answer_5094*>|5B. How much do you have left?|
<*Answer_5095*>|6. Please name as many animals as you can in one minute.| <*Answer_5096*>|7. What were the five objects I asked you to remember?| <*Answer_5097*>|8A. 87| <*Answer_5098*>|8B.
649| <*Answer_5099*>|8C. 8537| <*Answer_5100*>|9A. Hour markers:| <*Answer_5101*>|9B. Time:| <*Answer_5102*>|10A. Please place an X in the triangle.| <*Answer_5103*>|10B. Which figure
is the largest?| <*Answer_5104*>|11A. What was the female's name?| <*Answer_5105*>|11B. What work did she do?| <*Answer_5106*>|11C. When did she go back to work?| <*Answer_5107*>|11D.
What state did she live in?| <*Answer_5108*>|||Information contained in this note is based on a self-report assessment and is not sufficient to use alone for diagnostic purposes. Assessment
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