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Agency patient number:ID:RptPeriod:^Patient:Nom:CMS Assessment
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Birth date
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{mm/dd/yyyy}
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Hospital Name
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Observation date Spec
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NIH stroke scale interval:Find:Pt:^Patient:Nom:NIHSS
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Level of consciousness:Find:Pt:^Patient:Ord:NIHSS
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LOC questions:Find:Pt:^Patient:Ord:NIHSS
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LOC commands:Find:Pt:^Patient:Ord:NIHSS
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Best gaze:Find:Pt:^Patient:Ord:NIHSS
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Visual:Find:Pt:^Patient:Ord:NIHSS
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Facial palsy:Find:Pt:^Patient:Ord:NIHSS
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Motor arm:Find:Pt:Arm.left:Ord:NIHSS
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Motor arm:Find:Pt:Arm.right:Ord:NIHSS
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Motor leg:Find:Pt:Leg.left:Ord:NIHSS
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Motor leg:Find:Pt:Leg.right:Ord:NIHSS
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Limb ataxia:Find:Pt:^Patient:Ord:NIHSS
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Sensory:Find:Pt:^Patient:Ord:NIHSS
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Best language:Find:Pt:^Patient:Ord:NIHSS
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Dysarthria:Find:Pt:^Patient:Ord:NIHSS
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Extinction and inattention:Find:Pt:^Patient:Ord:NIHSS
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Total score:Score:Pt:^Patient:Qn:NIHSS
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{score}
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