Clayton Royal Hospital Behavioral Scale

1. Memory

Please select

Memory

Intact

Occasional forgetfulness

Short-term memory loss

Memory is short-lived or cannot remember

2. Orientation

Please select

Orientation

Well oriented

Can orient within home or workplace

Misrecognition of people

Cannot find way

Completely disoriented

3. Conversation

Please select

Conversation

Always clear

Can engage in simple conversations

Can understand simple questions but cannot express needs

Retains some ability to express

Cannot communicate

4. Cooperation

Please select

Cooperation

Actively cooperative

Passively cooperative

Requires persuasion

Refuses help

Resists or withdraws

5. Anxiety

Please select

Anxiety

None

Passive cooperation

Score: