This is a depression scale.
Acute Neurologic Changes
Onset prior to evaluation
Onset while:

Key Symptoms
<-- Weakness
<-- Change in sensation
<-- Facial droop
<-- Altered speech
<-- Altered swallowing
<-- Difficulty standing
<-- Vision change

Associated Symptoms
<-- Confusion
<-- Agitation
<-- Difficult to awaken
<-- Complete Loss of Consciousness (lasted )
<-- Seizure
<-- Headache
<-- Falls

Pertinent ROS
<-- fever
<-- dizziness
<-- chest pain
<-- palpitations
<-- shortness of breath
<-- cough
<-- nausea/vomiting
<-- abdominal pain
<-- dysuria
<-- urinary frequency
<-- rash

Pertinent PMH:
<-- Atrial Fibrillation
<-- Cerebrovascular Accident or TIA
<-- Dementia
<-- Coronary Artery Disease
<-- Diabetes Mellitus
<-- Head Trauma
<-- Serious CNS risks (e.g. active cancer, immunosuppression, HIV)
<-- Migraine Headaches
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