Free Neuropsychological Evaluation Template
Neuropsychological Evaluation
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Name: |
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Age: |
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Address: |
Date: [DATE]
Introduction: This form serves to evaluate neuropsychological functioning using standardized testing measures. This will encompass an in-depth assessment of cognitive, emotional, behavioral, and neurological statuses.
Overview: The comprehensive evaluation aims to understand various brain functions and behavior. It is anchored on systematic examinations through tests, interviews, and direct observations.
Evaluation Criteria:
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Cognitive Functioning: It assesses information processing speed, executive function, verbal and visuospatial abilities, attention, and memory.
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Emotional Functioning: It measures mood states, affective processing, and emotional recognition.
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Behavioral Functioning: It scrutinizes adaptive behaviors, personality traits, habits, and reactions.
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Neurological Functioning: It evaluates motor skills, sensory integration, coordination, and general neurological status.
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Adaptive Functioning: Ability to function effectively in daily life, including communication, self-care, social interactions, and independent living.
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Cranial Nerve Assessment, Motor and Sensory Evaluation: Clinical examination to assess cranial nerve function and motor/sensory abilities.
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Intelligence/Cognitive Abilities: Mental capacities including problem-solving, memory, attention, and language skills, assessed using tests like WAIS and Raven's Matrices.
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Social Cognition: Ability to understand and respond to social cues and situations, evaluated through tests assessing empathy, theory of mind, and social judgment.
Comprehensive Evaluation Form:
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Criteria |
Description |
Result and Findings |
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Cognitive functioning |
Assessment of abilities related to learning, problem-solving, decision-making, and other related cognitive functions. |
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Emotional functioning |
Evaluation of emotional responses, resilience, recognition, and understanding of personal emotions. |
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Behavioural functioning |
Measurement of actions and reactions in different situations, awareness of personal behavior. |
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Neurological functioning |
Inspection of overall neurological status including motor and sensory skills, balance and coordination, and spatial awareness. |
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Adaptive Functioning |
Cranial Nerve Assessment, Motor and Sensory Evaluation |
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Intelligence/Cognitive Abilities |
Wechsler Adult Intelligence Scale, Raven's Progressive Matrices |
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Social Cognition |
Reading the Mind in the Eyes Test, Social Perception Test |
Additional Comments/Notes:
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Comments/Notes |
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