Template library · Assessments & screeners
Cognitive Screen (MSE-Focused) template
Focused screen of cognitive domains for suspected cognitive impairment.
Brief cognitive screening within an MSE
- 16 fields across 4 sections
- Included with MyWellOps
- Edit it, or save your own version
What’s in it
Assessment Details
- Client NameText
- Date of BirthDate
- Client ID / MRNText
- Date of AssessmentDate
- Clinician / CoachText
- Location / ModalityText
Domains Assessed
- Orientation (person, place, time)Tick box
- Immediate recallTick box
- Short-term memoryTick box
- Attention / concentrationTick box
- LanguageTick box
- Visuospatial abilityTick box
- Executive functionTick box
Notes
- Findings and recommendation for further neuropsychological workupText
Signatures
- Clinician SignatureSignature
- Date signed (clinician)Date
When to use it
Use an assessment at the start of work to set a baseline, then repeat it at review points so you and the client can see what has changed.
How it works in MyWellOps
- Pick it from Documents.
- Send it to the client to complete, or fill it in together during a session.
- Each completed copy is kept on the client’s record, so earlier results are there to compare.
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