2. Patient name Date of birth Date of test Max. pointsPatient score Orientation 5()What is the (year) (season) (date) (day) (month)? 5()Where are we (country) (country) (town/city) (building) (floor)? 3() Registration Name three common objects (e.g. ‘apple’, ‘table’, ‘penny’). Take 1 second to say each. Then ask the patient to repeat all three after you have said them. Give 1 point for each correct answer. Then repeat them until he/she learns all three. Count trails and record. Trails()

3. 5() Attention Spell ‘world’ backwards. The score is the number of letters in the correct order. (D_L_R_O_W) 3() Recall Ask for the three objects repeated above. Give 1 point for each correct answer. (Note: recall cannot be tested if all three objects were not remembered during registration) 2() Language Name a ‘pencil’ and a ‘watch’. (2 points) 1()Repeat the following: ‘No ifs, ands or buts’ (1 point)

4. 3()Follow a three-stage command: ‘Take this paper in your right hand, fold it in half, and put it on the floor.’ (3 points) 1()Read and obey the following: (1 point) CLOSE YOUR EYES 1()Write a sentence. (1 point) 1()Copy the following design. Give 1 point if no construction problem 30()Total Examiner

5. The End