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Instructions Scale Definition Score - NIH Stroke Scale

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Patient Identification. ___ ___-___ ___ ___-___ ___ ___ Pt. Date of Birth ___ ___/___ ___/___ ___ Hospital ________________________(___ ___-___ ___) Date of Exam ___ ___/___ ___/___ ___ Interval: [ ] Baseline [ ] 2 hours post treatment [ ] 24 hours post onset of symptoms 20 minutes [ ] 7-10 days [ ] 3 months [ ] Other ________________________________(___ ___) Time: ___ ___:___ ___ [ ]am [ ]pm Person Administering Scale _____________________________________ Administer Stroke Scale items in the order listed. Record performance in each category after each subscale exam. Do not go back and change scores.

Patient Identification. ___ ___-___ ___ ___-___ ___ ___ Pt. Date of Birth ___ ___/___ ___/___ ___ Hospital _____(___ ___-___ ___) Date of Exam ___ ___/___ ___/___ ___

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