1a. What is the year?

1b. What is the season?

1c. What is the date?

1d. What is the day of the week?

1e. What is the month?

2a. In which province are we now?

2b. In which town are we now?

2c. In which hospital are we now?

2d. In which department are we now?

2e. On which floor are we now?

3. I will name three objects. Would you repeat them after I've said all three? Remember them, because I ask you to mention them again in a few minutes. Apple, Key, Table (repeat max 5 times until patient knows, give points after the first time)

4. I would like you to count backward from 100 by sevens.” (93, 86, 79, 72, 65, …), Stop after five answers

5. Earlier I told you the names of three things. Can you tell me what those were?

6. Show the patient a wristwatch and a pencil, and ask the patient to name them.

7. Repeat the phrase: ‘No ifs, ands, or buts.’

8. Take the paper in your right hand, fold it in half, and put it on the floor.” (The examiner gives the patient a piece of blank paper)

9. Please read this and do what it says.” (Written instruction is “Close your eyes.”)

10. Make up and write a sentence about anything.” (This sentence must contain a noun and a verb.)

11. Please copy this picture.” (The examiner gives the patient a blank piece of paper and asks him/her to draw the symbol below. All 10 angles must be present and two must intersect.)