Cognistat Five PDF Form

Cognistat Five© PDF Form is specifically designed to provide a risk assessment of delirium, Mild Cognitive Impairment and dementia.  It is based on three of the original Cognistat subtests: orientation, memory and constructions.  The test takes approximately five minutes to administer to normal patients and incorporates a sophisticated clinical-based algorithm, the MCI Index, a graded seven point measure of the risk of cognitive decline.

Cognistat Five Active Form provides a simplified graphic output that depicts the patient’s performance:

Cognistat Five Active Form

  • Computer-assisted and administered by a health-care professional.
  • An Adobe Active Form format which does not require web access.
  • Automatically generates a graphic profile and the MCI Index.
  • Allows data to be uploaded later to Cognistat Five for addition to a database.
  • Runs on Windows, Mac and iPad Systems.
  • Is fully HIPPA, HL7 and Part 11b compliant.

Purchase Cognistat Five Active Form

You will need Adobe Reader Version 10 or later for the PDF Form 10-day free trial.  If you do not have it you can download it here »