Personal Information | Admission information | History of current stroke |
Date of birth | Ward Class | Date of stroke onset |
Ethnicity | Date of admission | Type of stroke |
Gender | Date of discharge | First or recurrent stroke |
Marital Status | Stroke characteristics | |
-Side of hemiparesis | ||
Left | ||
Right | ||
-Stroke type | ||
Infarct | ||
Bleed | ||
Both | ||
Undefined | ||
-Stroke severity (according to Modified Ranking Scale) | ||
Co-existing conditions | Caregiver | Additional tests |
Cardiovascular disease | Spouse | Depression according to Center for Epidemiologic Studies – Depression Scale (CESD-11) |
Hypertension | Child | |
Peripheral vascular disease | Maid | |
Chronic obstructive pulmonary disease | Others | Cognitive function according to Mini-Mental State Exam (MMSE) |
Arthritis or other musculoskeletal condition | None | Euro-QOL (EQ-5D) |
Diabetes |