Galveston Orientation & Amnesia Test (Goat)
Name:
Date:
You are scoring errors
only
on this form!
0
1
2
What is your name? (2)
0
1
2
3
4
When were you born? (4)
0
1
2
3
4
Where do you live? (4)
0
1
2
3
4
5
0
1
2
3
4
5
Where are you now?
city? (5)
hospital? (5) (
unnecesary to state name of hospital
)
0
1
2
3
4
5
On what date were you admitted to this hospital? (5)
0
1
2
3
4
5
How did you get here? (5)
0
1
2
3
4
5
What is the first event you can remember
after
the injury? (5)
0
1
2
3
4
5
Can you describe in detail (eg. date, time, companions) the first event you can recall
after
the injury? (5)
0
1
2
3
4
5
Can you describe the last event you recall
before
the accident? (5)
0
1
2
3
4
5
Can you describe in detail (eg. date, time, companions) the first event you can recall
before
the injury? (5)
0
1
2
3
4
5
What time is it how? (
1 for each half hour removed from correct time to maximum of 5
)
0
1
2
3
4
5
What day of the week is it? (
1 for each day removed from correct one?
)
0
1
2
3
4
5
What day of the month is it? (
1 for each day removed from correct date to maximum of 5
)
0
5
10
15
What is the month? (
5 for each month removed from correct one to a maximum of 15
)
0
10
20
30
What is the year? (
10 for each year removed from correct one to maximum of 30
)
(100-total error points)