Cognitive Ability test

Chief Complaint

Cognitive ability

Form Content

Hello, my name is Emma, and I will help you complete the questionnaire portion of your Cognitive Ability Form. The information that you provide will be summarized for your physician and is needed to complete the exam. We estimate this questionnaire will take around 5 minutes to complete, If you must stop, you can return at a later time to finish. If you want me to repeat a question, just say "repeat." Are you ready? Cognitive Ability: This is a clock face. Please put in the hour markers and the time at ten minutes to eleven o’clock. ) - (draw_zone: [clock_panel_picture ]{ 0, 0, 320, 320 }) (correct answer get 1) (Instructions for scoring: Hour markers okay get 2, Time correct get extra 2) Please place an X in the triangle. ) - (draw_zone: [triangle-picture ]{ 0, 0, 179, 87 }) (correct answer get 1) Which of the the figures is largest. ) (correct answer get 1) 15. I am going to tell you a story. Please listen carefully because afterwards, I'm going to ask you some questions about it. "Jill was a very successful stockbroker. She made a lot of money on the stock market. She then met Jack, a devastatingly handsome man. She married him and had three children. They lived in Chicago. She then stopped work and stayed at home to bring up her children. When they were teenagers, she went back to work. She and Jack lived happily ever after." What was the female’s name? 16. When did she go back to work? 17. What work did she do? 18. What state did she live in?