Neurological Exam



Cranial Nerves–global assessment: FORMCHECKBOX Normal FORMCHECKBOX Abnormal (explain further in table below) FORMCHECKBOX Cannot Assess, explain: FORMCHECKBOX Other, specify:Table for Recording Which of the Following Cranial Nerves are AbnormalCranial Nerve NumberLateralityExplain AbnormalityCN II FORMCHECKBOX Left FORMCHECKBOX Right FORMCHECKBOX BilateralData to be entered by siteCN III FORMCHECKBOX Left FORMCHECKBOX Right FORMCHECKBOX BilateralData to be entered by siteCN IV FORMCHECKBOX Left FORMCHECKBOX Right FORMCHECKBOX BilateralData to be entered by siteCN V FORMCHECKBOX Left FORMCHECKBOX Right FORMCHECKBOX BilateralData to be entered by siteCN VI FORMCHECKBOX Left FORMCHECKBOX Right FORMCHECKBOX BilateralData to be entered by siteCN VII FORMCHECKBOX Left FORMCHECKBOX Right FORMCHECKBOX BilateralData to be entered by siteCN VIII FORMCHECKBOX Left FORMCHECKBOX Right FORMCHECKBOX BilateralData to be entered by siteCN IX FORMCHECKBOX Left FORMCHECKBOX Right FORMCHECKBOX BilateralData to be entered by siteCN X FORMCHECKBOX Left FORMCHECKBOX Right FORMCHECKBOX BilateralData to be entered by siteCN XI FORMCHECKBOX Left FORMCHECKBOX Right FORMCHECKBOX BilateralData to be entered by siteCN XII FORMCHECKBOX Left FORMCHECKBOX Right FORMCHECKBOX BilateralData to be entered by siteGeneral InstructionsThis CRF Module is recommended to collect information on cranial nerve function for subarachnoid hemorrhage (SAH) studies.The elements on this CRF are classified as Exploratory. ................
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