Allen Cognitive Level Screen Documentation

Document administration of the leather-lacing ACLS and record the Allen scale score, observed performance, and functional cognition notes.

Assessment Details

• Assessment Date
• Assessor Name
• Assessment Setting
• Reason for Screening
  Briefly note why the ACLS was administered.

ACLS Administration

• ACLS Version
• Standard Instructions Given
  Confirm that standard ACLS instructions were provided.
• Cueing Provided During Task
• Factors Affecting Performance
• Observed Performance Notes
  Describe observable behaviors during the lacing task, such as initiation, sequencing, error correction, and response to cues.

Scoring and Interpretation

• Allen Scale Score
  Enter the score from 3.0 to 5.8 in 0.1 increments if applicable.
• Score Confidence
• Functional Cognition Summary
  Summarize the estimated functional cognition level and learning capacity based on the observed ACLS performance.
• Recommended Support Level

Follow-Up and Documentation

• Follow-Up Recommendations
  Include any recommended therapy, supervision, environmental supports, or reassessment.
• Share Results With Care Team
• Documentation Notes
  Add any additional clinical notes relevant to the assessment record.