PHI stands for "Protected Health Information" (Y = Yes, N = No)
| Display | Field | Phi | Field type | Condition choices | Field note | Header | |
|---|---|---|---|---|---|---|---|
| <h6 style="background-color:#DA70D6">INTERVIEWER</h6>: Do you have reasonable suspicion from any source (e.g. behavior or appearance during interview, information from relatives, medical records) that subject may have a questionable mental status? Complete this section only if the subject's mental status is questionable else skip to Somatization | mmse_int | N | radio | 1, Yes | 0, No | 9, Unknown | - | - | |
| 1a. What is the: (Year)(Season)(Date)(Day)(Month)? | mmse_1a | N | text | - | Max Score: 5 | - | |
| 1b. Where are we:(Country)(State)(Town)(Hospital/Bldg)(Floor/Street)? | mmse_1b | N | text | - | Max Score: 5 | - | |
| Name three objects or concepts for the subject(e.g. fish hook, shoe, green) taking one second to say each.Tell subject s/he will be asked to recall them.Ask the subject to repeat all three after you have said them.Give one point for each correct answer.Repeat them until subject learns all three | mmse_registration | N | descriptive | - | - | - | |
| Trial 1: | mmse_trial1 | N | text | - | Max Score: 3 | - | |
| Trial 2: | mmse_trial2 | N | text | - | Max Score: 3 | - | |
| Trial 3: | mmse_trial3 | N | text | - | Max Score: 3 | - | |
| Trial 4: | mmse_trial4 | N | text | - | Max Score: 3 | - | |
| Trial 5: | mmse_trial5 | N | text | - | Max Score: 3 | - | |
| Trial 6: | mmse_trial6 | N | text | - | Max Score: 3 | - | |
| Serial 7's. Count backward from 100 by 7.Score one point for each correct.Stop after 5 answers. | mmse_att | N | text | - | Max Score: 5 | - | |
| Spell "world"(or some other 5-letter word) backward.Score one point for each letter in correct order | mmse_att2 | N | text | - | Max Score: 5 | - | |
| Ask the subject to name the three objects repeated above.Score one point for each | mmse_recall | N | text | - | Max Score: 3 | - | |
| 5a. Point to a pencil and watch.Ask the subject "What is this called?" for each.Score two points. | mmse_5a | N | text | - | Max Score: 2 | - | |
| 5b. Ask the subject to repeat the following "No ifs, ands, or buts."Score 1 point | mmse_5b | N | text | - | Max Score: 1 | - | |
| 5c. Ask the subject to follow a three-stage command (e.g. "Take a paper in your right hand, fold it in half, and put it on the floor") Score three points | mmse_5c | N | text | - | Max Score: 3 | - | |
| 6a. Hand the subject the MMS Card that reads "Close Your Eyes". | mmse_6a | N | text | - | Max Score: 1 | - | |
| 6b. Write a sentence. Score one point | mmse_6b | N | text | - | Max Score: 1 | - | |
| 6c. Copy the design below.Score one point | mmse_6c | N | text | - | Max Score: 1 | - | |
| 7. Total Score | mmse_tot | N | calc | sum([mmse_1a] , [mmse_1b] , max([mmse_trial1],[mmse_trial2],[mmse_trial3],[mmse_trial4],[mmse_trial5],[mmse_trial6]) , [mmse_att] , [mmse_att2] , [mmse_recall] , [mmse_5a] , [mmse_5b] , [mmse_5c] , [mmse_6a] , [mmse_6b] , [mmse_6c]) | - | - | |
| 8. <h6 style="background-color:#DA70D6">INTERVIEWER</h6>: Assess level of consciousness | mmse_consc | N | radio | 1, Alert | 2, Drowsy | 3, Stupor | - | - | |
| Notes: | modified_minimental_status_examinationcsv_notes | Y | notes | - | - | - |