Admit date
Contact Status
Date of Injury
Lesion Cause
Lesion Side
Lesion Site
Neuroradiological Report
Notes
Record No.
Six month date
Special Testing Circumstances--See COORDINATOR  (if checked)
TMS
viewexclude
Aphasia
Aphasia Description (if any)
Appointment Date
Appointment Notes
Approach Notes
Attending
Clinic Patient
Clinical Information Notes
Current Age
Date
Date of Birth
Date of Contact
Date of Testing (grant info)
Examiner
Examiner1
Examiner2
Examiner3
Examiner4
Examiner5
Examiner6
Examiner7
Examiner8
Examiner9
Examiner10
Examiner 11
Examiner 12
Examiner 13
Examiner 14
Examiner 15
Examiner 16
Examiner 17
Examiner 18
Examiner 19
Examiner 20
Examiner 21
Examiner 22
Examiner 23
Examiner 24
Examiner 25
Examiner 26
Examiner 27
Examiner 28
Examiner 29
Examiner 30
Examiner 31
Examiner 32
Exclusionary
Extinction
Film Notes
Films Approved
Films Requested
FU Date
FU Phone Call
Grant No. (grant info)
Hemiparesis
Hospital
Hospital Record Obtained
If Y, Hospital Record Obtained
Last Date Coordinator Checked for Appt
Last Date When Checked for Neuroradiology Reports
Last Name Tester
Lesion Cause 1
Lesion Cause 2
Lesion Cause 3
Lesion Cause 4
Lesion Cause 5
Lesion Side 1
Lesion Side 2
Lesion Side 3
Lesion Side 4
Lesion Side 5
Lesion Site 1
Lesion Site 2
Lesion Site 3
Lesion Site 4
Lesion Site 5
Location of Visual Defect
MRI Possible?
MRN
Name of Control
Neglect
No Films Available
Patient Outside of HUP
Patient Says "OKAY" to Participate
Protocol No. (grant info)
Protocol Title (grant info)
Reason, if N
Record Notes
REMOVED RECORDS
Scheduled Appointment
Scheduling Notes
Scheduling Notes y or n
Sex
Side
Side of Extinction
Side of Neglect
Subcortical
Testdate1
Testdate2
Testdate3
Testdate4
Testdate5
Testdate6
Testdate7
Testdate8
Testdate9
Testdate10
Testdate 11
Testdate 12
Testdate 13
Testdate 14
Testdate 15
Testdate 16
Testdate 17
Testdate 18
Testdate 19
Testdate 20
Testdate 21
Testdate 22
Testdate 23
Testdate 24
Testdate 25
Testdate 26
Testdate 27
Testdate 28
Testdate 29
Testdate 30
Testdate 31
Testdate 32
tester exam 1
tester exam 2
tester examiner 1
tester examiner 2
Tests Administered
Today
Today's Date
Visual Field Defect
