PATIENT’S NAME: J.R.

T AGE: 45 years old

GENDER: M BIRTHDATE: JULY 30, 1975
ADDRESS: MANILA CITY

MINI-MENTAL STATUS EXAMINATION

ORIENTATION TO TIME AND PLACE
QUESTIONNAIRES RESPONSE SCORE

Ano ang petsa ngayon? MARCH 2, 2022 1

Anong araw ngayon? WENDNESDAY 1

Ano ang panahon o season TAG INIT 1

ngayon?

Ano ang pangalan ng lugar SAN ANDRES EXT. 1

na ito?

Nasaang palapag or floor 1st floor 1

tayo ngayon?

Nasaang barangay tayo 780 1

ngayon?)

Nasaang siyudad tayo MANILA 1

ngayon?)

Nasaang bansa kayo PILIPINAS 1

ngayon?

TOTAL 8/8

REGISTRATION
QUESTIONNAIRES SCORE NO. OF TRIAL

Able to say “MANGGA- 2 3

MESA- PERA”.

TOTAL 2/3 3/6

ATTENTION AND CALCULATION

QUESTIONNAIRES SCORE

Able to spell “E-N-R-A-K” (5 PTS) 5

PATIENT’S NAME: J.R.T AGE: 45 years old
GENDER: M BIRTHDATE: JULY 30, 1975
ADDRESS: MANILA CITY

DELAYED RECALL
QUESTIONNAIRES SCORE

Able to recall “MANGGA- MESA- PERA”. 3

TOTAL 3/3

LANGUAGE

A. Naming
QUESTIONNAIRES SCORE

Able to recognize “WRISTWATCH” 1

Able to recognize “PENCIL” 1

TOTAL 2/2

b. Repetition
QUESTIONNAIRES SCORE

Able to say correctly “Minikaniko ni 0

Monika ang Makina.”

TOTAL 0/1

c. 3-step command
COMMANDS SCORE

“Kunin itong papel gamit ang (say the 1

NON-DOMINANT hand) kanan/kaliwang
kamay’

tiklupin sa gitna, 1

ilagay sa iyong kandungan”. 1

TOTAL 3/3
PATIENT’S NAME: J.R.T AGE: 45 years old
GENDER: M BIRTHDATE: JULY 30, 1975
ADDRESS: MANILA CITY

d. Reading comprehension
QUESTIONNAIRES SCORE

Able to close his eyes 0

TOTAL 0/1

e. Writing
QUESTIONNAIRES SCORE

Able to write a sentence 1

“JULIUS NAGLINIS NG BAHAY ”

TOTAL 1/1

f. Copying and visuo-spatial function

QUESTIONNAIRES SCORE

Able to draw the figure 1

TOTAL 1/1
PATIENT’S NAME: J.R.T AGE: 45 years old
GENDER: M BIRTHDATE: JULY 30, 1975
ADDRESS: MANILA CITY

CLOCK DRAWING TEST (CDT)

COMMANDS SCORE

Drawing of a closed circle 1

Presence of all the 12 numbers 1

Placement of the numbers in the correct 1

quadrants and position

Placement of the hands of the clock in the 0

correct position

TOTAL 3/4
PATIENT’S NAME: J.R.T AGE: 45 years old
GENDER: M BIRTHDATE: JULY 30, 1975
ADDRESS: MANILA CITY

SUMMARY

SCORES

ORIENTATION TO TIME AND PLACE 8

REGISTRATION 2

ATTENTION AND CALCULATION 5

DELAYED RECALL 3

LANGUAGE 5

CLOCK DRAWING TEST (CDT) 3

TOTAL SCORES 27/30

RESULT: NORMAL