[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-166770-105":53,"doc-detail-166770-en":126},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","mental-status-neurological-exam-form","Mental Status - Neurological Exam Form","","Neurological Exam mental status documentation capturing structured observations used to screen eligibility and support baseline or follow-up assessments. The form organizes recording for cranial nerves and neuro-motor domains including nystagmus, weakness pattern and location, tremor type, cerebellar/coordination elements, reflex characterization, limb reflex tone patterns, plantar response, gait abnormalities, and sensory system findings with symmetry, distribution, and modalities. It also includes guidance on when the module is supplemental, how data elements may be adapted to study hypotheses, and which suggested screening tools support attention, working memory, and episodic or remote memory.",{"@graph":63,"@context":118},[64,80,101],{"@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-neurological-exam-form/166770/",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-neurological-exam-form/166770.png","ImageObject",442,249,{"name":88,"@type":89},"Chloe Bennett","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/vnd.openxmlformats-officedocument.wordprocessingml.document","2026-09-24","2026-08-31",true,{"@type":98,"interactionType":99,"userInteractionCount":73},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What are the main purposes of the neurological exam mental status section?","Question",{"text":108,"@type":109},"It is generally administered at screening and/or baseline to determine study eligibility, and it may be used at follow-up visits to track participants’ physical status. The module is supplemental for certain clinical research types rather than intended for all studies.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"How does the form handle follow-up exams compared with a prior exam?",{"text":113,"@type":109},"If follow-up, the form prompts the examiner to indicate whether there is no change, improvement, worsening, unknown status, or other specified changes from the prior exam.",{"name":115,"@type":106,"acceptedAnswer":116},"What suggested screening tools are provided for cognitive domains in adults?",{"text":117,"@type":109},"Attention is assessed using forward digit span-6, working memory with reverse digit span-4, and recent episodic memory with recall of 3 objects after a 5-minute delay. Remote (semantic) memory is assessed by listing verifiable historical or personal events.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},166770,1790232580,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":73,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":135,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":76},962084925782,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","Date of Exam: //20 (m m dd yyyy)\nIf follow-up exam, change from prior exam:\n\u0013 FORMCHECKBOX \u0014\u0015No change\n\u0013 FORMCHECKBOX \u0014\u0015Improved\n\u0013 FORMCHECKBOX \u0014\u0015Worse\n\u0013 FORMCHECKBOX \u0014\u0015Unknown\n\u0013 FORMCHECKBOX \u0014\u0015Other, specify:\nMental Status\nTable for Mental Assessments\n\u000f\nCranial Nerves\nCranial Nerves–global assessment:\n\u0013 FORMCHECKBOX \u0014\u0015Normal\n\u0013 FORMCHECKBOX \u0014\u0015Abnormal (explain further in questions 5a through 5k below)\n\u0013 FORMCHECKBOX \u0014\u0015Cannot Assess, explain:\n\u0013 FORMCHECKBOX \u0014\u0015Other, specify:\nTable for Recording Which of the Following Cranial Nerves are Abnormal\nNystagmus:\n\u0013 FORMCHECKBOX \u0014\u0015Yes (Specify type below) \u0013 FORMCHECKBOX \u0014\u0015No \u0013 FORMCHECKBOX \u0014\u0015Cannot Assess, explain:\nType of Nystagmus:\n\u0013 FORMCHECKBOX \u0014\u0015Physiologic \u0013 FORMCHECKBOX \u0014\u0015Abnormal \u0013 FORMCHECKBOX \u0014\u0015Other, specify:\u000f\nMotor\nTable for Recording Motor Assessments\nWeakness? \u0013 FORMCHECKBOX \u0014\u0015Yes (answer questions 10a and 10b) \u0013 FORMCHECKBOX \u0014\u0015No\nDoes the weakness suggest one of the following patterns?\n\u0013 FORMCHECKBOX \u0014\u0015Right Hemiparesis\n\u0013 FORMCHECKBOX \u0014\u0015Left Hemiparesis\n\u0013 FORMCHECKBOX \u0014\u0015Diplegia/Paraparesis\n\u0013 FORMCHECKBOX \u0014\u0015Quadriplegia/Quadraparesis\n\u0013 FORMCHECKBOX \u0014\u0015Peripheral Nerve Lesion(s), describe:\n\u0013 FORMCHECKBOX \u0014\u0015Neuropathic Weakness, describe:\n\u0013 FORMCHECKBOX \u0014\u0015Myopathic Weakness, describe:\n\u0013 FORMCHECKBOX \u0014\u0015Other, specify:\nSpecify the neurological location of the weakness:\n\u0013 FORMCHECKBOX \u0014\u0015Brain\n\u0013 FORMCHECKBOX \u0014\u0015Spinal Cord\n\u0013 FORMCHECKBOX \u0014\u0015Peripheral Nervous System\n\u0013 FORMCHECKBOX \u0014\u0015Other, specify:\nTremor?\n\u0013 FORMCHECKBOX \u0014\u0015Yes (Specify type below)\n\u0013 FORMCHECKBOX \u0014\u0015No\n\u0013 FORMCHECKBOX \u0014\u0015Cannot Assess, explain:\n\u0013 FORMCHECKBOX \u0014\u0015Other, specify:\nType of Tremor:\n\u0013 FORMCHECKBOX \u0014\u0015Postural\n\u0013 FORMCHECKBOX \u0014\u0015Rest\n\u0013 FORMCHECKBOX \u0014\u0015Intention\n\u0013 FORMCHECKBOX \u0014\u0015Other, specify:\n\u000f\nCerebellar/Coordination\nTable for Recording Cerebellar/Coordination Assessments\nReflexes\nReflexes–global assessment:\n\u0013 FORMCHECKBOX \u0014\u0015Normal\n\u0013 FORMCHECKBOX \u0014\u0015Abnormal (Continue to 15a and 15b)\n\u0013 FORMCHECKBOX \u0014\u0015Cannot Assess\n\u0013 FORMCHECKBOX \u0014\u0015Other, specify:\nAssessment of Limbs\nRight Arm:\n\u0013 FORMCHECKBOX \u0014\u0015Increased with clonus\n\u0013 FORMCHECKBOX \u0014\u0015Increased without clonus\n\u0013 FORMCHECKBOX \u0014\u0015Hypoactive\n\u0013 FORMCHECKBOX \u0014\u0015Absent\nLeft Arm:\n\u0013 FORMCHECKBOX \u0014\u0015Increased with clonus\n\u0013 FORMCHECKBOX \u0014\u0015Increased without clonus\n\u0013 FORMCHECKBOX \u0014\u0015Hypoactive\n\u0013 FORMCHECKBOX \u0014\u0015Absent\nRight Leg:\n\u0013 FORMCHECKBOX \u0014\u0015Increased with clonus\n\u0013 FORMCHECKBOX \u0014\u0015Increased without clonus\n\u0013 FORMCHECKBOX \u0014\u0015Hypoactive\n\u0013 FORMCHECKBOX \u0014\u0015Absent\nLeft Leg:\n\u0013 FORMCHECKBOX \u0014\u0015Increased with clonus\n\u0013 FORMCHECKBOX \u0014\u0015Increased without clonus\n\u0013 FORMCHECKBOX \u0014\u0015Hypoactive\n\u0013 FORMCHECKBOX \u0014\u0015Absent\nPlantar Response\nRight:\n\u0013 FORMCHECKBOX \u0014\u0015Flexor\n\u0013 FORMCHECKBOX \u0014\u0015Extensor\n\u0013 FORMCHECKBOX \u0014\u0015Equivocal\n\u0013 FORMCHECKBOX \u0014\u0015Cannot Assess\n\u0013 FORMCHECKBOX \u0014\u0015Other, specify:\nLeft:\n\u0013 FORMCHECKBOX \u0014\u0015Flexor\n\u0013 FORMCHECKBOX \u0014\u0015Extensor\n\u0013 FORMCHECKBOX \u0014\u0015Equivocal\n\u0013 FORMCHECKBOX \u0014\u0015Cannot Assess\n\u0013 FORMCHECKBOX \u0014\u0015Other, specify:\nGait\nGait–global assessment:\u0013 FORMCHECKBOX \u0014\u0015 Normal \u0013 FORMCHECKBOX \u0014\u0015 Abnormal (Indicate type below) \u0013 FORMCHECKBOX \u0014\u0015Cannot Assess \u0013 FORMCHECKBOX \u0014\u0015Other, specify:\nType of Abnormal Gait:\n\u0013 FORMCHECKBOX \u0014\u0015Ataxic Gait\n\u0013 FORMCHECKBOX \u0014\u0015Hemiparetic Gait–Left side\n\u0013 FORMCHECKBOX \u0014\u0015Hemiparetic Gait–Right side\n\u0013 FORMCHECKBOX \u0014\u0015Diplegic Gait\n\u0013 FORMCHECKBOX \u0014\u0015Parkinsonian Gait\n\u0013 FORMCHECKBOX \u0014\u0015Other Gait Abnormalities, specify:\nSensory/Sensation\nSensory System–global assessment:\n\u0013 FORMCHECKBOX \u0014\u0015Normal\n\u0013 FORMCHECKBOX \u0014\u0015Abnormal (Continue to 17a–17d)\n\u0013 FORMCHECKBOX \u0014\u0015Cannot Assess\n\u0013 FORMCHECKBOX \u0014\u0015Other, specify:\nSymmetry of Abnormality:\n\u0013 FORMCHECKBOX \u0014\u0015Symmetric \u0013 FORMCHECKBOX \u0014\u0015Asymmetric\nLocation of Abnormality (Select all that apply):\n\u0013 FORMCHECKBOX \u0014\u0015Stocking, explain:\n\u0013 FORMCHECKBOX \u0014\u0015Stocking/Glove, explain:\n\u0013 FORMCHECKBOX \u0014\u0015Dermatome, explain:\n\u0013 FORMCHECKBOX \u0014\u0015Sensory Nerve, explain:\n\u0013 FORMCHECKBOX \u0014\u0015Other, specify:\nPatient Description of abnormal symptoms:\nSensory Modalities Affected (Select all that apply):\n\u0013 FORMCHECKBOX \u0014\u0015Light Touch\n\u0013 FORMCHECKBOX \u0014\u0015Pain and Temperature\n\u0013 FOR","cbCailOhTECCceSC","https://ap.wps.com/l/cbCailOhTECCceSC","docx",48980,7,"English","# Mental Status\n## Cranial Nerves\n## Motor\n## Tremor\n## Cerebellar/Coordination\n## Reflexes\n## Gait\n## Sensory/Sensation\n## Recommended for pediatric studies ONLY\n## General Instructions\n## Suggested Screening Tools","[{\"question\":\"What are the main purposes of the neurological exam mental status section?\",\"answer\":\"It is generally administered at screening and/or baseline to determine study eligibility, and it may be used at follow-up visits to track participants’ physical status. The module is supplemental for certain clinical research types rather than intended for all studies.\"},{\"question\":\"How does the form handle follow-up exams compared with a prior exam?\",\"answer\":\"If follow-up, the form prompts the examiner to indicate whether there is no change, improvement, worsening, unknown status, or other specified changes from the prior exam.\"},{\"question\":\"What suggested screening tools are provided for cognitive domains in adults?\",\"answer\":\"Attention is assessed using forward digit span-6, working memory with reverse digit span-4, and recent episodic memory with recall of 3 objects after a 5-minute delay. Remote (semantic) memory is assessed by listing verifiable historical or personal events.\"}]","Mental Status - Neurological Exam Form | DOCX",1788200712]