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    CFS6 19HF

    Uploaded by

    Hbk Rajneesh
    rajneesh patel

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    CFS6 19HF

    Uploaded by

    Hbk Rajneesh
    535 views1 page
    rajneesh patel

    Original Title

    CFS6-19HF

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    © © All Rights Reserved

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    rajneesh patel

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    Download as pdf or txt
    535 views1 page

    CFS6 19HF

    Uploaded by

    Hbk Rajneesh
    rajneesh patel

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    NEUROLOGICAL ASSESSMENT FLOW SHEET

    INSTRUCTIONS: Document the date and time of each assessment, then proceed as follows:
    LEVEL OF CONSCIOUSNESS - Check () the appropriate response*.
    PUPIL RESPONSE - Check () PERL* if applicable or enter the appropriate code* for each eye.
    MOTOR FUNCTIONSHAND GRASPS - Enter the appropriate code*.
    EXTREMITIES - Check () the appropriate column(s)*.
    PAIN RESPONSE - Check () the appropriate column*.
    VITALS - Record blood pressure, temperature, pulse and respiration in the appropriate columns.
    Use the OBSERVATION column to note the presence or absence of specific resident conditions and place signature in the appro-
    priate column to verify documentation. * In all instances, refer to the legends provided at the bottom of the form.
    *LEVEL OF * PUPIL MOTOR FUNCTIONS *PAIN
    DATE TIME CONSCIOUSNESS VITALS OBSERVATIONS SIGNATURE
    RESPONSE * EXTREMITIES RESPONSE (i.e. seizures, headaches,
    *HAND
    vomiting, paralysis)
    A D S C PERL RIGHT LEFT GRASPS MA RU LU RL LL U AB A I AB BP TEMP P R

    o m

    E
    r p .c
    o

    ww
    . B r i gg s C

    P L
    A
    w
    M 4 7 - 2 3 4 3

    S
    ) 2
    0 0
    (8

    CONSCIOUSNESS PUPIL RESPONSE HAND GRASPS EXTREMITIES PAIN RESPONSE


    A - Alert PERL- Pupils equal and = - Hand grasps equal MA - Moves all extremities A - Appropriate pain
    D - Drowsy reactive to light R>L - Right grasp greater RU - Moves right arm response
    B - Brisk
    S - Stuporous than left LU - Moves left arm I - Inappropriate pain
    S - Sluggish
    C - Comatose NR - Nonreactive L>R - Left grasp greater than right RL - Moves right leg response
    PP - Pinpoint LL - Moves left leg
    DIL - Dilated
    U - Unable to follow commands AB - No response to pain
    U - Unable to follow commands
    FX - Fixed AB - Absent AB - Absent

    NAMELast First Middle Attending Physician Record No. Room/Bed

    CFS 6-19HF Rev. 12/03 1992 BRIGGS, Des Moines, IA (800) 247-2343 NEUROLOGICAL ASSESSMENT FLOW SHEET
    Unauthorized copying or use violates copyright law. www.BriggsCorp.com PRINTED IN U.S.A.

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