Neurological Assessment Flowsheet
Document neurological status and key assessment findings for clinical monitoring.
Patient Full Name
*
First Name
Last Name
Date and Time of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Patient ID or Medical Record Number
*
Level of Consciousness (GCS)
*
Rows
Eye Opening (E)
Verbal Response (V)
Motor Response (M)
Score
4 - Spontaneous
3 - To Speech
2 - To Pain
1 - None
5 - Oriented
4 - Confused
3 - Inappropriate Words
2 - Incomprehensible Sounds
1 - None
6 - Obeys Commands
5 - Localizes Pain
4 - Withdraws from Pain
3 - Flexion to Pain
2 - Extension to Pain
1 - None
Pupil Size and Reaction
*
Rows
Size (mm)
Reaction to Light
Right Pupil
Brisk
Sluggish
Non-reactive
Left Pupil
Brisk
Sluggish
Non-reactive
Motor Strength (0=No movement, 5=Normal)
*
Rows
Right Arm
Left Arm
Right Leg
Left Leg
Strength
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
Sensory Function (Touch/Pain)
*
Rows
Right Arm
Left Arm
Right Leg
Left Leg
Sensation
Normal
Decreased
Absent
Normal
Decreased
Absent
Normal
Decreased
Absent
Normal
Decreased
Absent
Cranial Nerve Assessment
Pupillary Response (CN II, III)
Facial Movement (CN VII)
Eye Movement (CN III, IV, VI)
Hearing (CN VIII)
Swallow/Gag (CN IX, X)
Tongue Movement (CN XII)
Other
Reflexes
Biceps
Triceps
Patellar
Achilles
Plantar (Babinski)
Other
Coordination and Speech
Normal Coordination
Ataxia
Aphasia
Dysarthria
Other
Additional Observations / Comments
Assessor Name and Credentials
*
Signature of Assessor
*
Submit Assessment
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