Montreal Cognitive Assessment (MoCA) Cognitive Screening

This template covers the core steps of a MoCA screening: administrator verification, assessment conditions, domain scoring, total score, interpretation, and follow-up. It is designed to capture the information needed to show the screening was administered consistently and scored in a traceable way. It does not replace clinical judgment or a full diagnostic evaluation.

A trained clinician or other authorized administrator should conduct the MoCA and complete the record according to your organization’s policy. The template includes a place to verify administrator certification or qualification so the record shows who performed the screening. If your workflow uses assistants for setup or intake, the final scoring and interpretation should still be reviewed by the responsible professional.

Use frequency should follow the purpose of the screening and the organization’s policy, such as baseline intake, periodic monitoring, or follow-up after a concern is identified. This template is flexible enough for one-time screenings or repeated assessments over time. If you repeat it, keep the conditions as consistent as possible so score changes are easier to interpret.

No. The MoCA is a screening tool, not a diagnosis. This template helps document the score and the next step, such as referral, repeat screening, or clinical review, but diagnosis requires appropriate medical evaluation. The interpretation field should always be used in line with your policy and the participant’s clinical context.

The template includes a field to record whether an education adjustment was applied, since MoCA scoring may be interpreted differently based on educational background. That field helps prevent a common documentation gap where the final score is recorded but the adjustment rationale is missing. Your organization should define who is allowed to apply the adjustment and how it is documented.

Common mistakes include missing consent or assent, failing to note hearing or vision limitations, using a distracting room, and recording only the total score without the domain breakdown. Another frequent issue is documenting a score without noting interruptions or deviations from standard instructions. This template prompts the administrator to capture those details before the record is closed.

Yes. You can customize the intake fields, interpreter notes, follow-up options, and communication workflow to match your clinic, occupational health program, or research protocol. If you use translated instructions or an interpreter, document that clearly so the screening context is preserved. Keep the scoring structure intact so the result remains comparable across uses.

The template can be used as a structured form before being entered into an EHR, quality system, or case management record. Because it separates administration conditions, domain scores, and interpretation, it maps well to structured data fields and audit review. That makes it easier to track completion, review deviations, and support follow-up actions.