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Click ‘Get Form’ to open it in the editor.
Begin by entering the inmate's name, date, DOC number, and institution at the top of the form. Ensure all information is accurate for proper documentation.
Proceed to the movement ratings section. Carefully observe and rate each type of movement based on severity from 0 (None) to 4 (Severe). Use the provided codes for clarity.
In the facial and oral movement section, assess movements such as frowning or puckering. Rate these movements accordingly using the specified codes.
Continue through extremity movements and trunk movements sections, observing and rating any abnormal movements noted during your examination.
Finally, complete the cooperation level and dental status sections by marking appropriate responses based on your observations and inquiries with the inmate.

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