1. Alternating Trail Making (Trail B): Connect numbers and letters in alternating sequence (1-A-2-B-3-C-4-D-5-E).

2. Cube Copying: Copy the cube exactly as shown.

3. Clock Drawing: Draw a clock, set the time to ’10 past 11′.

Contour (1 point):

Numbers (1 point):

Hands (1 point):

4. Lion?

5. Rhinoceros?

6. Camel?

7. Delayed Recall (5 words): How many were recalled without any cues?

8. Forward Digit Span: Recalled 5 digits correctly (e.g., 2 1 8 5 4)?

9. Backward Digit Span: Recalled 3 digits backwards correctly (e.g., 7 4 2)?

10. Letter A Tapping: Tapped when the letter ‘A’ was spoken in a sequence of letters?

11. Serial 7s: Successfully subtracted 7 from 100 three times (93, 86, 79)?

12. Repetition Sentence 1: “I only know that John is the one to help today.”

13. Repetition Sentence 2: “The cat always hid under the couch when dogs were in the room.”

14. Fluency (F-words): Generated 11 or more words starting with ‘F’ in 1 minute?

15. Similarity: Train – Bicycle (e.g., means of transportation)?

16. Similarity: Watch – Ruler (e.g., measuring instruments)?

17. Date (Day, Month, Year, Day of Week, Place, City)?

18. Month?

19. Year?

20. Day of Week?

21. Place (e.g., name of hospital/clinic)?

22. City?