Aphasia Assessment Documentation

Standardized form for documenting expressive and receptive language performance, naming, and comprehension during an aphasia evaluation to establish baseline findings and therapy goals.

Assessment Details

• Assessment Date
• Assessment Type
• Standardized Aphasia Test Used
  Enter the test name and version used for scoring and interpretation.
• Test Language
• Other Test Language
• Reason for Referral
  Briefly document the clinical reason for the aphasia assessment.

Communication History

• Primary Medical Diagnosis
  Examples: stroke, traumatic brain injury, tumor, neurodegenerative condition.
• Onset Date
• Prior Speech-Language Therapy
• Current Communication Supports
• Hearing or Vision Factors Affecting Testing
  Document any sensory or environmental factors that may influence test performance.

Expressive Language

• Verbal Output Level
• Word-Finding Difficulty
• Confrontation Naming Accuracy (%)
• Repetition Performance
• Expressive Language Notes
  Document paraphasias, perseveration, apraxia of speech, circumlocution, and other observable findings.

Receptive Language

• Auditory Comprehension Level
• One-Step Command Following
• Two-Step Command Following
• Yes/No Reliability
• Receptive Language Notes
  Include comprehension breakdowns, need for repetition, cueing level, and response accuracy.

Reading, Writing, and Functional Communication

• Reading Comprehension
• Writing Ability
• Functional Communication in Daily Tasks
• Effective Communication Strategies
• Functional Communication Notes
  Document how the impairment affects participation, safety, and daily communication.

Clinical Impression, Goals, and Submission

• Overall Aphasia Severity
• Clinical Impression
  Summarize the aphasia profile, key strengths, and primary limitations.
• Initial Therapy Goals
  Document measurable goals or target areas for treatment planning.
• Consent / Disclosure Acknowledgment
  Use minimum necessary information and avoid collecting PII that is not needed for care.
• Submission Notes
  Optional additional notes for the reviewer. After submission, the record will be available for clinical review and audit trail tracking.