| RPT |
.| .| Short Test of Mental Status| | Date Given: <.Date_Given.>| Clinician: <.Staff_Ordered_By.>| Location: <.Location.>| | Veteran: <.Patient_Name_Last_First.>| SSN: <.Patient_SSN.>| DOB:
complete and correct.| <*Answer_5590*>| | 8. Information| 8A. Who is the current president of the United States?| <*Answer_5591*>| 8B. Who was the first president of the United States?|
<*Answer_5592*>| 8C. Define an ISLAND.| <*Answer_5593*>| 8D. How many weeks are there in a year?| <*Answer_5594*>| | 9. Recall| 9A. Recall APPLE| <*Answer_5595*>| 9B. Recall
MR. JOHNSON| <*Answer_5596*>| 9C. Recall CHARITY| <*Answer_5597*>| 9D. Recall TUNNEL| <*Answer_5598*>| | Copyright (c) 1987, Mayo Clinic Foundation. | | 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.| $~
<.Patient_Date_Of_Birth.> (<.Patient_Age.>)| Gender: <.Patient_Gender.>| | | STMS Score: <-STMS Score->| | Questions and Answers| | 1. Orientation| 1A. What is your name?| <*Answer_5569*>| 1B. What
is your address?| <*Answer_5570*>| 1C. What building are we in now?| <*Answer_5571*>| 1D. In what city are we now located?| <*Answer_5572*>| 1E. What state are we in now?|
<*Answer_5573*>| 1F. What is today's date?| <*Answer_5574*>| 1G. What month is it?| <*Answer_5575*>| 1H. What year is it?| <*Answer_5576*>| | 2. Attention| 2A. Digit Span:
2-9-6-8-3| <*Answer_5577*>| 2B. Digit Span: 5-7-1-9-4-6| <*Answer_5578*>| 2C. Digit Span: 2-1-5-9-3-6-2| <*Answer_5579*>| | 3. Immediate Recall| 3A. How many trials were needed to
learn all, some or none of the four words?| <*Answer_5580*>| 3B. How many words were learned?| <*Answer_5599*>| | 4. Calculation| 4A. What is 5 times 13?| <*Answer_5581*>| 4B. What
is 65 minus 7?| <*Answer_5582*>| 4C. What is 58 divided by 2?| <*Answer_5583*>| 4D. What is 29 plus 11?| <*Answer_5584*>| | 5. Abstraction| 5A. How are ORANGE and BANANA alike?|
<*Answer_5585*>| 5B. How are DOG and HORSE alike?| <*Answer_5586*>| 5C. How are TABLE and BOOKCASE alike?| <*Answer_5587*>| | 6. Construction| 6A. Clock face is circular, and numbers
are correctly placed.| <*Answer_5588*>| 6B. The time is correctly drawn.| <*Answer_5589*>| | 7.Copy the line drawing of a three dimensional cube (Necker's cube). The subject's drawing is
|
