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Physician Form

Montreal Cognitive Assessment (MoCA)

A downloadable Physician form for healthcare professionals.
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Specialty

Physician

Downloads

170 times

Type

Form

Last edited

7/24/2026

Created by

Heidi Team

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About this form

The Montreal Cognitive Assessment (MoCA) is used to assess cognitive function. Designed for physicians in Canada, this form captures essential patient details and assessment findings to help identify cognitive impairments. By streamlining the evaluation process, clinicians can focus on delivering high-quality patient care while minimising delays in diagnosis. Selecting this form supports clinical practice through organised documentation and comprehensive assessment.

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Frequently asked questions

What is the purpose of the Montreal Cognitive Assessment (MoCA) PDF?

The purpose of the Montreal Cognitive Assessment (MoCA) PDF is to detect mild cognitive impairment using a standardized one-page cognitive screening instrument. Designed for physicians in the UK and originally developed in Canada, this form captures patient details and assessment findings across seven cognitive domains. The tool is used to help identify cognitive impairments, supporting clinical practice through organized documentation. This structured evaluation process allows you to focus on high-quality patient care while minimizing delays in diagnosis.

Who uses the Montreal Cognitive Assessment (MoCA) PDF?

You use this form as a trained and certified clinician administering and scoring the assessment. The patient you are assessing performs all the tasks during the session, such as trail-making, clock drawing, word recall and sentence repetition. As the administrator, you are responsible for scoring each domain in real time, calculating the total score and Memory Index Score, applying any education correction and noting your name in the 'Administered by' field. The form's protocol requires you to hold current training and certification.

What is included in a Montreal Cognitive Assessment (MoCA) PDF?

A Montreal Cognitive Assessment (MoCA) PDF includes patient identifiers, the date of administration and scores across seven cognitive domains, culminating in a total score and a Memory Index Score.

  • Patient name, education level, sex and date of birth
  • Date of administration
  • Visuospatial/executive scores for trail-making, cube copy and clock drawing
  • Naming scores for three animals
  • Attention scores for digit span, letter tapping and serial subtractions
  • Language scores for sentence repetition and verbal fluency
  • Abstraction scores for two similarity pairs
  • Delayed recall scores with cue tracking
  • Orientation scores for date, month, year, day, place and city
  • Total score out of 30 and Memory Index Score (MIS) out of 15
  • Education correction flag
  • Administrator name

Common Problems of Completing Montreal Cognitive Assessment (MoCA) PDFs

Intricate Scoring for Subtraction and Memory Tasks

Accurately calculating the final score requires close attention to several specific rules. For example, the serial 7 subtraction task has a tiered scoring system where the number of points depends on the count of correct responses. Similarly, calculating the Memory Index Score involves tracking uncued recall points alongside category and multiple-choice cues from the delayed recall subscale. Applying these specific scoring rules correctly in real time, especially with borderline responses, adds a layer of complexity to the administration.

The Five-Minute Wait for Delayed Recall

The assessment requires a 5-minute delay between the memory registration and delayed recall tasks. During this interval, you administer other attention and language tasks. Managing this sequence effectively while keeping the patient engaged can be challenging. It is easy to lose track of the timing or the flow of the intervening tasks, especially when also managing a patient who may be experiencing fatigue or distress. This makes the delayed recall component a common point of procedural difficulty.

Documenting Domain-Level Score Breakdowns

Simply documenting the total score in the patient's record is often insufficient for longitudinal tracking or specialist review. A more useful note includes the breakdown of scores across all seven cognitive domains, the total score, the Memory Index Score and whether the education correction was applied. Manually transcribing all of this detail from the form into the patient record consistently across encounters is a time-consuming administrative task that can easily be overlooked in a busy clinical setting.

Benefits of Using Heidi to Auto-Fill Montreal Cognitive Assessment (MoCA) PDFs

Your Post-Assessment Note, Structured and Ready

After completing the assessment, you need to document the results in the patient's record. Heidi drafts the clinical note from the domain scores, including the total score, Memory Index Score, any education correction and a full domain-level breakdown. This ensures the result is structured consistently for every assessment. The note also surfaces the patient’s prior scores from the clinical record, enabling longitudinal comparison. You review and confirm the draft before it enters the record.

Key Thresholds Flagged for Interpretation

When interpreting the assessment, you need to consider the normal score threshold and the education correction rule. Heidi automatically flags the total score against the 26/30 normal threshold and highlights when the education correction applies for patients with 12 years or fewer of education. This provides immediate context for the interpretation section of your note, so it accurately reflects the result without you needing to manually check the criteria each time.

Patient Details Pre-Filled Before You Start

Before the assessment begins, you need to fill out the patient's demographic information. Heidi pre-populates the patient's name, education level, sex, date of birth and the date of administration directly from their structured profile. This means the patient identifiers and administrator field are ready to go before the session starts, saving you from manual data entry and letting you focus entirely on administering the assessment for the patient.

How to use this form

1

Auto-fill with Heidi

Click "Auto-fill Form with Heidi" to open the form in Heidi and complete the fields straight from your note, no copying and pasting.

2

Review and edit

Check the pre-filled details and make any changes before finalising the form.

3

Download or save

Download the completed form or save it directly into your patient records and workflows.

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