Stroke Neurological Assessment Checklist Form
Complete this checklist to assess key neurological functions relevant to stroke evaluation. Please answer each section based on your observations.
Level of Consciousness
*
Alert
Drowsy
Unresponsive
Speech Clarity
*
Normal
Slurred
Aphasic
Facial Symmetry (Smile/Grimace)
*
Symmetrical
Partial Weakness
Complete Weakness
Arm Strength (Drift Test)
*
Normal
Drifts Down
No Movement
Leg Strength
*
Normal
Drifts Down
No Movement
Gaze Deviation
*
Normal
Partial Deviation
Forced Deviation
Visual Fields
*
Normal
Partial Loss
Complete Loss
Coordination (Finger-to-Nose)
*
Normal
Ataxic
Unable
Sensation (Light Touch)
*
Normal
Reduced
Absent
Overall Assessment Comments
Submit Assessment
Should be Empty: