Name | Value |
---|---|
REPORT NUMBER | 2 |
INSTRUMENT | FAST |
RPT | |Functional Assessment Staging |Gender: <.Patient_Gender.> | |FAST Stage: <-Stage-> | | Stage 1: Normal adult | Stage 2: Normal older adult | Stage 3: Early dementia | Stage 4: Mild dementia | Stage 5: Moderate dementia | Stage 6: Moderately severe dementia | | Stage 7: Severe dementia | |Questions and Answers | |<*Answer_7771*> |<*Answer_7772*> |<*Answer_7773*> |<*Answer_7774*> |<*Answer_7775*> |<*Answer_7776*> |Date Given: <.Date_Given.> |<*Answer_7777*> |<*Answer_7778*> |<*Answer_7779*> |<*Answer_7780*> |<*Answer_7781*> |<*Answer_7782*> |<*Answer_7783*> |<*Answer_7784*> |<*Answer_7785*> |<*Answer_7786*> |Clinician: <.Staff_Ordered_By.> | |Copyright (c) 1984 by Barry Reisberg, M.D., Reproduced with permission. | |Information contained in this note is based on a self-report assessment and is not sufficient to use alone for diagnostic purposes. Assessment results should be verified for accuracy and used in conjunction with other diagnostic activities and procedures. |Location: <.Location.> | |Veteran: <.Patient_Name_Last_First.> |SSN: <.Patient_SSN.> |DOB:<.Patient_Date_Of_Birth.> (<.Patient_Age.>) |