Loading
Get Mini Cog Test
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the Mini Cog Test online
The Mini Cog Test is a simple yet effective tool used to assess cognitive function. This guide provides clear instructions to help users successfully fill out the assessment form online.
Follow the steps to complete the Mini Cog Test online.
- Press the ‘Get Form’ button to acquire the Mini Cog Test form and access it in your preferred online editor.
- In the first section, inform the patient that they will listen to and remember three words: Ocean, Desk, and Tractor. Ask them to repeat these words back to you after a moment.
- Instruct the patient to draw the face of a clock. Ensure they include all the numbers and set the hands to point at 8:20. You can repeat this instruction if necessary, but do not provide any additional guidance.
- If the patient is unable to complete the clock drawing within three minutes, proceed to the final step.
- Next, ask the patient to repeat the three words you provided at the beginning.
- Record the words the patient remembers by circling them. Allocate one point for each correct word recalled.
- Evaluate the clock drawing test. It is considered normal if all numbers are present and correctly placed, and if the hands clearly show the specified time. Assign 2 points for a normal result or 0 points for an abnormal result.
- Calculate the total score by adding the word recall score and the clock drawing score. Refer to the scoring guidelines, where a total score of 0–2 indicates a positive screen for dementia, while a score of 3–5 indicates a negative screen.
- Once all information has been filled out, you can choose to save your changes, download the document, print it, or share the completed form as needed.
Take the next step in managing cognitive health and fill out the Mini Cog Test online.
Three-Word Recall Examples would be “banana, sunrise, chair,” or “daughter, heaven, mountain.” Then the test-taker is asked to draw a clock (see below). After completing the drawing, the test-taker is asked to repeat the three words that were spoken at the beginning of the test.
Industry-leading security and compliance
US Legal Forms protects your data by complying with industry-specific security standards.
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.