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Captures hygiene and grooming, apparent age, dressing appropriateness, notable physical features, and evidence of injuries or scars. Includes behavioral observations such as eye contact, cooperation, and psychomotor activity; evaluates speech characteristics; assesses mood and affect, thought process and content, perception, cognition, insight, and judgment. Provides space for narrative notes, provider signature, and assessment date.",{"@graph":63,"@context":111},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/mental-status-exam-mse-form-general-appearance/166763/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/mental-status-exam-mse-form-general-appearance/166763.png","ImageObject",442,249,{"name":88,"@type":89},"Ethan Miller","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/vnd.openxmlformats-officedocument.wordprocessingml.document","2026-09-26","2026-08-31",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",6,{"@type":103,"mainEntity":104},"FAQPage",[105],{"name":106,"@type":107,"acceptedAnswer":108},"What cognitive domains does the form assess?","Question",{"text":109,"@type":110},"It evaluates alertness/consciousness, orientation to person/place/time/situation, attention and concentration (tasks and results), memory (immediate/short-term/long-term), and abstract reasoning (similarities and proverb interpretation).","Answer","https://schema.org",{"og:url":78,"og:type":113,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":115,"canonical":78},"index,follow",{"doc_id":117,"site_id":56},166763,1788200671,{"code":4,"msg":5,"data":120},{"doc_id":117,"user_id":121,"nickname":88,"user_avatar":122,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":123,"file_id":124,"file_url":125,"file_type":126,"file_size":127,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":76,"language":128,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":129,"faqs":130,"seo_title":131,"seo_description":61,"update_tm":118,"read_time":9},687207017582,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","Mental Status Exam (MSE) Form\nPatient Name: _________________________\nDate of Assessment: ___________________\nProvider Name: ________________________\nSetting: ☐ Inpatient ☐ Outpatient ☐ Emergency ☐ Other: ____________\nGeneral Appearance\nHygiene/Grooming: ☐ Good ☐ Fair ☐ Poor\nApparent Age: ☐ Appears stated age ☐ Younger ☐ Older\nDress: ☐ Appropriate ☐ Inappropriate ☐ Disheveled ☐ Bizarre\nNotable Features: _______________________________\nEvidence of injuries/scars: ☐ Yes ☐ No | Describe: ___________________\nBehavior\nEye Contact: ☐ Appropriate ☐ Poor ☐ Intense ☐ Avoidant\nCooperation: ☐ Cooperative ☐ Guarded ☐ Hostile ☐ Suspicious\nPsychomotor Activity: ☐ Normal ☐ Agitated ☐ Restless ☐ Slowed ☐ Tics ☐ Tremors ☐ Rigidity ☐ Other: ____________\nMannerisms: _______________________________\nSpeech\nRate: ☐ Normal ☐ Pressured ☐ Slow\nVolume: ☐ Normal ☐ Loud ☐ Soft\nTone: ☐ Normal ☐ Monotone ☐ Emotional\nFluency: ☐ Fluent ☐ Hesitant ☐ Slurred (dysarthria) ☐ Other: ____________\nMood and Affect\nMood (subjective): “How do you feel today?”\nPatient’s Response: ___________________________________________\nAffect (objective): ☐ Appropriate ☐ Inappropriate ☐ Blunted ☐ Flat ☐ Labile ☐ Anxious ☐ Euphoric ☐ Irritable ☐ Agitated\nCongruent with mood? ☐ Yes ☐ No\nThought Process\n☐ Logical ☐ Coherent ☐ Goal-directed\n☐ Circumstantial ☐ Tangential ☐ Flight of ideas ☐ Loose associations\n☐ Disorganized ☐ Blocking ☐ Perseveration ☐ Other: ____________\nThought Content\nSuicidal Ideation: ☐ Denied ☐ Present | Plan? ☐ Yes ☐ No\nHomicidal Ideation: ☐ Denied ☐ Present | Plan? ☐ Yes ☐ No\nDelusions: ☐ None ☐ Persecutory ☐ Grandiose ☐ Somatic ☐ Religious ☐ Referential ☐ Other: ____________\nObsessions/Compulsions: ☐ Yes ☐ No | Describe: ___________________\nPerception\nHallucinations: ☐ None ☐ Auditory ☐ Visual ☐ Tactile ☐ Olfactory ☐ Gustatory\nIllusions: ☐ Yes ☐ No | Describe: ___________________\nCognition\nA. Alertness/Consciousness: ☐ Alert ☐ Lethargic ☐ Stuporous ☐ Unresponsive ☐ Other: ____________\nB. Orientation: Person: ☐ Oriented ☐ Disoriented, Place: ☐ Oriented ☐ Disoriented, Time: ☐ Oriented ☐ Disoriented, Situation: ☐ Oriented ☐ Disoriented\nC. Attention and Concentration: Tasks: ☐ Digit span ☐ Serial 7s ☐ Spell “world” backward\nResults: ___________________________________________\nFocus: ☐ Sustained ☐ Easily distracted\nD. Memory: Immediate recall: __________________________\nShort-term memory: ________________________\nLong-term memory: _________________________\nE. Abstract Reasoning: Similarities (e.g., apple and orange): ____________________\nProverb interpretation (e.g., “Don’t cry over spilled milk”): ____________________\nInsight\n☐ Good ☐ Fair ☐ Limited ☐ Poor\nComments: _________________________________________\nJudgment\nScenario (e.g., “What would you do if you found a stamped envelope on the ground?”):\nPatient’s Answer: _______________________________________\nHistory-based Assessment (e.g., medication adherence): ☐ Adequate ☐ Poor\nAdditional Notes/Observations\n__________________________________________________________________\n__________________________________________________________________\n__________________________________________________________________\nProvider Signature: _______________________\nDate: ___________________","cbCaioDi6f2RVi5s","https://ap.wps.com/l/cbCaioDi6f2RVi5s","docx",52398,"English","# General Appearance\n## Hygiene/Grooming and Dress\n# Behavior\n## Eye Contact and Cooperation\n## Psychomotor Activity and Mannerisms\n# Speech\n# Mood and Affect\n# Thought Process\n# Thought Content\n# Perception\n# Cognition\n## Alertness/Consciousness and Orientation\n## Attention and Memory\n## Abstract Reasoning","[{\"question\":\"What cognitive domains does the form assess?\",\"answer\":\"It evaluates alertness/consciousness, orientation to person/place/time/situation, attention and concentration (tasks and results), memory (immediate/short-term/long-term), and abstract reasoning (similarities and proverb interpretation).\"}]","Mental Status Exam (MSE) Form - General Appearance | DOCX"]