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Run: Allen Cognitive Level Screen Documentation

Document an Allen Cognitive Level Screen with the leather-lacing ACLS, score the Allen scale, and capture functional cognition notes in one place. Use it to ...

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Assessment Details

Assessment Date (required)

Assessor Name (required)

Assessment Setting (required)

Reason for Screening

Briefly note why the ACLS was administered.

ACLS Administration

ACLS Version (required)

Standard Instructions Given (required)

Confirm that standard ACLS instructions were provided.

Yes No N/A

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 (required)

Enter the score from 3.0 to 5.8 in 0.1 increments if applicable.

Score Confidence

Functional Cognition Summary (required)

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

Yes No N/A

Documentation Notes

Add any additional clinical notes relevant to the assessment record.

Get your results

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