| A. Mental status |
| 1. Level of alertness |
| 2. Language |
| a. Fluency |
| b. Comprehension |
| c. Repetition |
| d. Naming |
| e. Reading |
| f. Writing |
| 3. Memory |
| a. Immediate |
| b. Short-term |
| c. Long-term |
| i. Recent (including orientation to place and time) |
| ii. Remote |
| 4. Calculation |
| 5. Construction |
| 6. Abstraction |
| B. Cranial nerves |
| 1. Olfaction (CN I) |
| 2. Vision (CN II) |
| a. Visual fields |
| b. Visual acuity |
| c. Funduscopic examination |
| 3. Pupillary light reflex (CNs II, III) |
| 4. Eye movements (CNs III, IV, VI) |
| 5. Facial sensation (CN V) |
| 6. Facial strength |
| a. Muscles of mastication (CN V) |
| b. Muscles of facial expression (CN VII) |
| 7. Hearing and vestibular function (CN VIII) |
| 8. Palatal movement (CNs IX, X) |
| 9. Dysarthria (CNs IX, X, XII) |
| 10. Head rotation (CN XI) |
| 11. Shoulder elevation (CN XI) |
| 12. Tongue movements (CN XII) |
