Neurological Nursing Assessment Form
Patient Information
Name
Date of Birth
Medical Record Number
Assessment Date
Time
Assessed by
Level of Consciousness
Consciousness Level
Alert
Lethargic
Stuporous
Comatose
Description
Pupil Assessment
Pupil Size (Left)
Reaction to Light (Left)
Brisk
Sluggish
None
Pupil Size (Right)
Reaction to Light (Right)
Brisk
Sluggish
None
Motor Response
Strength (Left Upper Limb)
Strength (Right Upper Limb)
Strength (Left Lower Limb)
Strength (Right Lower Limb)
Facial Symmetry
Sensory Response
Response to Touch/Pain
Speech
Speech Description
Cranial Nerve Assessment
Cranial Nerve Findings
Glasgow Coma Scale (GCS)
Eye Opening (E)
Verbal Response (V)
Motor Response (M)
Total Score
Vital Signs
Blood Pressure
Pulse
Temperature
Respiratory Rate
Other Observations
Notes