Name	Value
REPORT NUMBER	4
INSTRUMENT	CDR
RPT	.\|.\|Clinical Dementia Rating\|\|Date Given: <.Date_Given.>\|Clinician: <.Staff_Ordered_By.>\|Location: <.Location.>\|\|Veteran: <.Patient_Name_Last_First.>\|SSN: <.Patient_SSN.>\|DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)\|Gender: <.Patient_Gender.>\|\|Dementia Rating\| CDR: <-CDR->\|\|Questions and Answers\|\|1. Memory\| <Answer_3903>\|2. Orientation\| <Answer_3904>\|3. Judgment and Problem Solving\| <Answer_3905>\|4. Community Affairs\| <Answer_3906>\|5. Home and Hobbies\| <Answer_3907>\|6. Personal Care\| <Answer_3908>\|\|\|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.\| $~

Name

Value

REPORT NUMBER

INSTRUMENT

RPT

.|.|Clinical Dementia Rating||Date Given: <.Date_Given.>|Clinician: <.Staff_Ordered_By.>|Location: <.Location.>||Veteran: <.Patient_Name_Last_First.>|SSN: <.Patient_SSN.>|DOB: 
<.Patient_Date_Of_Birth.> (<.Patient_Age.>)|Gender: <.Patient_Gender.>||Dementia Rating|   CDR: <-CDR->||Questions and Answers||1. Memory|    <*Answer_3903*>|2. Orientation|    
<*Answer_3904*>|3. Judgment and Problem Solving|    <*Answer_3905*>|4. Community Affairs|    <*Answer_3906*>|5. Home and Hobbies|    <*Answer_3907*>|6. Personal Care|    <*Answer_3908*>|||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.|    $~

4 (4) MH REPORT (601.93)