The Galveston Orientation and Amnesia Test
Harvey S. Levin, Ph.D., Vincent M. O'Donnell, M.A., & Robert G. Grossman, M.D.

Instructions:  Can be administered Daily.  Score of 78 or more on three consecutive occasions is considered to indicate that patient is out of post-traumatic amnesia (PTA).

Question

Error Score

Notes
What is your name? -2 _____ Must give both first name and surname.
When were you born? -4 _____ Must give day, month, and year.
Where do you live? -4 _____ Town is sufficient.
Where are you now:    
     (a) City -5 _____ Must give actual town.
     (b) Building -5 _____ Usually in hospital or rehab center.  Actual name necessary.
When were you admitted to this hospital? -5 _____ Date.
How did you get here? -5 _____ Mode of transport.
What is the first event you can remember after the injury? -5 _____ Any plausible event is sufficient (record answer)
Can you give some detail? -5 _____ Must give relevant detail.
Can you describe the last event you can recall before the accident? -5 _____ Any plausible event is sufficient (record answer)
What time is it now? -5 _____ -1 for each half-hour error.
What day of the week is it? -3 _____ -1 for each day error.
What day of the month is it? (i.e. the date) -5 _____ -1 for each day error.
What is the month? -15 _____ -5 for each month error.
What is the year? -30 _____ -10 for each year error.

Total Error:

   
Total Actual Score = (100 - total error) = 100 - _____ =   Can be a negative number.
76-100 = Normal / 66-75 = Borderline / <66 = Impaired    
Developed by Harvey Levin, Ph.D., Vincent M. O'Donnell, M.A., & Robert G. Grossman, M.D.    

 

Tracking Chart
100                            
                             
90                            
                             
80                            
                             
70                            
                             
60                            
                             
50                            
                             
40                            
                             
30                            
                             
20                            
                             
10                            
                             
0                            
Date ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____