0 - SPONTANEOUS: eyes open with sleep/wake rhythms, indicating active arousal mechanisms; does not assume awareness.
1 - TO SPEECH AND/OR SENSORY STIMULATION: a response to any verbal approach, whether spoken or shouted, not necessarily the command to open the eyes. Also, response to touch, mild pressure.
2 - TO PAIN: tested by a painful stimulus.
3 - NONE: no eye opening even to painful stimulation.

If patient cannot use voice because of tracheostomy, is aphasic or dysarthric, or has vocal cord paralysis or voice dysfunction, then estimate patient’s best response and enter note under comments.

0 - ORIENTED: implies awareness of self and the environment. Patient is able to tell you a) who they are; b) where they are; C) why they are there; d) year; e) season; f) month; g) day; h) time of day.
1 - CONFUSED: attention can be held and patient responds to questions but responses are delayed and/or indicate varying degrees of disorientation and confusion.
2 - INAPPROPRIATE: intelligible articulation but speech is used only in an exclamatory or random way (such as shouting and swearing); no sustained communication exchange is possible.
3 - INCOMPREHENSIBLE: moaning, groaning, or sounds without recognizable words; no consistent communication signs.
4 - NONE: no sounds or communications signs from patient.

0 - OBEYING: obeying command to move finger on best side. If no response or not suitable, try another command such as move lips, blink eyes, etc. Do not include grasp or other reflex responses.
1 - LOCALIZING: a painful stimulus at more than one site causes a limb to move (even slightly) in an attempt to remove it. It is a deliberate motor act to move away from or remove the source of noxious stimulation. If there is doubt as to whether withdrawal or localization has occurred after 3 or 4 painful stimulations, rate as localization.
2 - WITHDRAWING: any generalized movement away from a noxious stimulus that is more than a simple reflex response.
3 - FLEXING: painful stimulation results in either flexion at the elbow, rapid withdrawal with abduction of the shoulder, or a slow withdrawal with adduction of the shoulder. If there is confusion between flexing and withdrawing, use pin prick on hands, then face.
4 - EXTENDING: painful stimulation results in extension of the limb.
5 - NONE: no response can be elicited. Usually associated with hypotonia. Exclude spinal transection as an explanation of lack of response; be satisfied that an adequate stimulus has been applied.

Rate each of the 3 functions separately. For each function, answer the question, “Does the patient show awareness of how and when to perform each specified activity?” Ignore motor disabilities that interfere with carrying out a function. (This is rated under Level of Functioning described below.) Rate best response for toileting based on bowel and bladder behavior. Grooming refers to bathing, washing, brushing of teeth, shaving, combing or brushing of hair, and dressing.

0 - COMPLETE: continuously shows awareness that they know how to feed, toilet, or groom self and can convey unambiguous information that they know when this activity should occur.
1 - PARTIAL: intermittently shows awareness that they know how to feed, toilet, or groom self and/or can intermittently convey reasonably clear information that they know when the activity should occur.
2 - MINIMAL: shows in a primitive way how to feed, toilet, or groom self and/or shows infrequently by certain signs, sounds, or activities that they are vaguely aware of when the activity should occur.
3 - NONE: shows virtually no awareness at any time that they know how to feed, toilet, or groom self and cannot convey information by signs, sounds, or activity that they know when the activity should occur.

0 - COMPLETELY INDEPENDENT: able to live as they wish, requiring no restriction due to physical, mental, emotional, or social problems.
1 - INDEPENDENT IN SPECIAL ENVIRONMENT: capable of functioning independently when needed requirements are met (mechanical aids).
2 - MILDLY DEPENDENT: able to care for most of own needs but requires limited assistance due to physical, cognitive, and/or emotional problems (eg, needs nonresident helper).
3 - MODERATELY DEPENDENT: able to care for self partially but needs another person at all times.
4 - MARKEDLY DEPENDENT: needs help with all major activities and the assistance of another person at all times.
5 - TOTALLY DEPENDENT: not able to assist in own care and requires 24-hour nursing care.

The psychosocial adaptability or employability item takes into account overall cognitive and physical ability to be an employee, homemaker, or student This determination should take into account considerations such as the following:

1. Able to understand, remember, and follow instructions;
2. Can plan and carry out tasks at least at the level of an office clerk or ri simple routine, repetitive industrial situations, or can do school assignments;
3. Ability to remain oriented, relevant, and appropriate in work and other psychosocial situations;
4. Ability to get to and from work or shopping centers using private or public transportation effectively;
5. Ability to deal with number concepts;
6. Ability to make purchases and handle simple money exchange problems;
7. Ability to keep track of time schedules and appointments.

0 - NOT RESTRICTED: can compete in the open market for a relatively wide range of jobs commensurate with existing skills; or can initiate, plan, execute, and assume responsibilities associated with homemaking; or can understand and carry out most age-relevant school assignments.
1 - SELECTED JOBS, COMPETITIVE: can compete in a limited job market for a relatively narrow range of jobs because of limitations of the type described above and/or because of some physical limitations; or can initiate, plan, execute, and assume many but not all responsibilities associated with homemaking; or can understand and carry out many but not al school assignments.
2 - SHELTERED WORKSHOP, NON-COMPETITIVE: cannot compete successfully in job market because of limitations described above and/or because of moderate or severe physical limitations; or cannot without major assistance initiate, plan, execute, and assume responsibilities for homemaking; or cannot understand and carry out even relatively simple school assignments without assistance.
3 - NOT EMPLOYABLE: completely unemployable because of extreme psychosocial limitations of the type described above; or completely unable to initiate, plan, execute, and assume any responsibilities associated with homemaking; or cannot understand or carry out any school assignments.

Place date of rating at top of column. Place appropriate rating next to each of the eight items listed. Add eight ratings together to obtain total DR score.