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Diagnosed by Western Medicine | |
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Age |
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DSQ | |
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Stable treatment history for at least 4 weeks | |
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Modified Hoehn and Yahr scale |
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Mini-Mental State Examination |
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With at least one disease as listed following: | |
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Allergy to Chinese herbal medicine | |
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Pregnancy or are breast feeding |
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Systolic Blood Pressure | mmHg |
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Heart Rate | t/s |
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Diastolic Blood Pressure | mmHg |
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Body Weight | kg |
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General Consultation |
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Total Score |
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Total Score |
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Total Score |
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Dyskinesias | |
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Interfere with ratings | |
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H&Y Stage |
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Total Score |
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Total Score |
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Total Score |
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Part 1 Score |
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Part 2 Score |
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Part 3 Score |
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Part 4 Score |
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Part 5 Score |
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Part 6 Score |
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Part 7 Score |
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Part 8 Score |
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Part 9 Score |
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Part 10 Score |
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Part 11 Score |
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Total Score |
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Systolic Blood Pressure | mmHg |
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Diastolic Blood Pressure | mmHg |
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Heart Rate | t/s |
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Body Weight | kg |
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General Consultation |
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Total Score |
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Total Score |
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Total Score |
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Dyskinesias | |
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Interfere with ratings | |
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H&Y Stage |
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Total Score |
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Total Score |
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Total Score |
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Part 1 Score |
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Part 2 Score |
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Part 3 Score |
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Part 4 Score |
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Part 5 Score |
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Part 6 Score |
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Part 7 Score |
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Part 8 Score |
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Part 9 Score |
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Part 10 Score |
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Part 11 Score |
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Total Score |
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|
Systolic Blood Pressure | mmHg |
|
Heart Rate | t/s |
|
Diastolic Blood Pressure | mmHg |
|
Body Weight | kg |
|
General Consultation |
|
|
Total Score |
|
|
Total Score |
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|
Total Score |
|
|
Dyskinesias | |
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Interfere with ratings | |
|
H&Y Stage |
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|
Total Score |
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Total Score |
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|
Total Score |
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Part 1 Score |
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Part 2 Score |
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Part 3 Score |
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Part 4 Score |
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Part 5 Score |
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Part 6 Score |
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Part 7 Score |
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Part 8 Score |
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Part 9 Score |
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Part 10 Score |
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|
Part 11 Score |
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|
Total Score |
|
|
Systolic Blood Pressure | mmHg |
|
Diastolic Blood Pressure | mmHg |
|
Heart Rate | t/s |
|
Body Weight | kg |
|
General Consultation |
|
|
Total Score |
|
|
Total Score |
|
|
Total Score |
|
|
Dyskinesias | |
|
Interfere with ratings | |
|
H&Y Stage |
|
|
Total Score |
|
|
Total Score |
|
|
Total Score |
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|
Part 1 Score |
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Part 2 Score |
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Part 3 Score |
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Part 4 Score |
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Part 5 Score |
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Part 6 Score |
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Part 7 Score |
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Part 8 Score |
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Part 9 Score |
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Part 10 Score |
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Part 11 Score |
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Total Score |
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