Cognitive Test

Chief Complaint

Cognitive Test

Form Content

There are 3 questions. Introduction (Show the following message at the beginning): Hello, my name is Emma and I am going to help you complete the Cognitive Test. The information that you provide will be summarized for your physician and is needed to complete the exam. This process will take about 30 minutes to complete. If you must stop, you can come back at a later time to finish. If you want me to repeat a question, just say “repeat”. Are you ready? 1. What's your name and please spell it I am now going to ask you some questions to test your Cognitive ability. What is the year? What state are we in? You have $100 and you go to the store and buy a dozen apples for $3 and a tricycle for $20. - How much did you spend? - How much do you have left? 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]{0,0,160,160}) (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) End. (Show the following information when questionary complete) Thank you for your time! Your information has been saved. We’ll share this with your healthcare provider.[end](https://resource.empathia.net/web/images/pre-visit/chat-finished.png)