Advanced Practice Series®: Kai Tailfeather Mental Status Exam
Mental Status Exam
Observations
Appearance ☒ Neat ☒ Well-Groomed ☐ Disheveled ☐ Inappropriate
☐ Unkempt ☐ Appears Younger Than Age
☐ Appears Older Than Age
Build/Stature ☐ Appropriate for Age ☐ Underweight ☒ Overweight
Posture ☐ Excellent ☒ Good ☐ Average ☐ Poor ☐ Very Poor
Speech ☒ Normal ☐ Tangential ☐ Pressured ☐ Impoverished
Eye Contact ☒ Normal ☐ Intense ☐ Avoidant ☐ Intermittent
Motor Activity ☒ Normal ☐ Restless ☐ Tics ☐ Slowed
☐ Impulsive ☐ Agitated
Affect ☒ Full ☐ Constricted ☐ Flat ☐ Labile
Comments:
Attitudes
Attitude Toward Examiner ☒ Cooperative ☐ Defensive
☐ Open ☐ Seductive
☐ Hostile ☐ Evasive
☐ Manipulative ☐ Ingratiating
☐ Over-Compliant ☐ Withdrawn
Attitude Toward ☒ Not Applicable ☐ Anxious
Parent/Guardian ☐ Positive Interaction ☐ Clings; Willing to Can
(For Minors Only) ☐ Ignores Separate
☐ Disrespectful ☐ Cannot Separate
Mood
Mood ☐ Euthymic ☐ Euphoric
☒ Anxious ☐ Irritable
☐ Angry ☐ Silly
☐ Depressed ☐ Cooperative
Comments:
Cognition
Orientation Impairment ☐ None ☒ Place ☒ Object ☒ Person ☒ Time
Recent Memory ☒ Intact ☒ Mild Impairment ☐ Moderate Impairment
☐ Severe Impairment
Remote Memory ☒ Intact ☐ Mild Impairment ☐ Moderate Impairment
☐ Severe Impairment
Attention ☒ Full ☐ Distracted ☐ Inattentive
Comments:
Perception
Hallucinations ☒ None ☐ Olfactory
☐ Auditory ☐ Gustatory
800 Country Club Road, P.O. Box 2540, Waterbury, CT 06723 | 1.800.749.2427 | SentinelU.com 1
Mental Status Exam
Observations
Appearance ☒ Neat ☒ Well-Groomed ☐ Disheveled ☐ Inappropriate
☐ Unkempt ☐ Appears Younger Than Age
☐ Appears Older Than Age
Build/Stature ☐ Appropriate for Age ☐ Underweight ☒ Overweight
Posture ☐ Excellent ☒ Good ☐ Average ☐ Poor ☐ Very Poor
Speech ☒ Normal ☐ Tangential ☐ Pressured ☐ Impoverished
Eye Contact ☒ Normal ☐ Intense ☐ Avoidant ☐ Intermittent
Motor Activity ☒ Normal ☐ Restless ☐ Tics ☐ Slowed
☐ Impulsive ☐ Agitated
Affect ☒ Full ☐ Constricted ☐ Flat ☐ Labile
Comments:
Attitudes
Attitude Toward Examiner ☒ Cooperative ☐ Defensive
☐ Open ☐ Seductive
☐ Hostile ☐ Evasive
☐ Manipulative ☐ Ingratiating
☐ Over-Compliant ☐ Withdrawn
Attitude Toward ☒ Not Applicable ☐ Anxious
Parent/Guardian ☐ Positive Interaction ☐ Clings; Willing to Can
(For Minors Only) ☐ Ignores Separate
☐ Disrespectful ☐ Cannot Separate
Mood
Mood ☐ Euthymic ☐ Euphoric
☒ Anxious ☐ Irritable
☐ Angry ☐ Silly
☐ Depressed ☐ Cooperative
Comments:
Cognition
Orientation Impairment ☐ None ☒ Place ☒ Object ☒ Person ☒ Time
Recent Memory ☒ Intact ☒ Mild Impairment ☐ Moderate Impairment
☐ Severe Impairment
Remote Memory ☒ Intact ☐ Mild Impairment ☐ Moderate Impairment
☐ Severe Impairment
Attention ☒ Full ☐ Distracted ☐ Inattentive
Comments:
Perception
Hallucinations ☒ None ☐ Olfactory
☐ Auditory ☐ Gustatory
800 Country Club Road, P.O. Box 2540, Waterbury, CT 06723 | 1.800.749.2427 | SentinelU.com 1