The Galveston Orientation and Amnesia Test

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The Galveston Orientation and Amnesia Test

Instructions: Can be administered Daily. Score of 78 or more on three consecutive occasions is considered to indicate that patient is out of post-traumatic amnesia (PTA).
Nomor identifikasi : Nama Responden Pemeriksa : : Umur : tahun Tanggal :

Question What is your name? When were you born? Where do you live? Where are you now: (a) City (b) Building When were you admitted to this hospital? How did you get here? What is the first event you can remember after the injury? Can you give some detail? Can you describe the last event you can recall before the accident? What time is it now? What day of the week is it? What day of the month is it? (i.e. the date) What is the month? What is the year? Total Error: Total Actual Score = (100 total error) = 100 - _____ = 76-100 = Normal / 66-75 = Borderline / <66 = Impaired
Catatan Pemeriksa :

Error Score -2 _____ -4 _____ -4 _____ -5 _____ -5 _____ -5 _____ -5 _____ -5 _____

Notes Must give both first name and surname. Must give day, month, and year. Town is sufficient. Must give actual town. Usually in hospital or rehab center. Actual name necessary. Date. Mode of transport. Any plausible event is sufficient (record answer) Must give relevant detail. Any plausible event is sufficient (record answer) -1 for each half-hour error. -1 for each day error. -1 for each day error. -5 for each month error. -10 for each year error. Can be a negative number.

-5 _____ -5 _____

-5 _____ -3 _____ -5 _____ -15 _____ -30 _____

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