Diagnosed by Western Medicine | |
Age |
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DSQ | |
Stable treatment history for at least 4 weeks | |
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: | |
Allergy to Chinese herbal medicine | |
Pregnancy or are breast feeding |
Systolic Blood Pressure | mmHg |
Heart Rate | t/s |
Diastolic Blood Pressure | mmHg |
Body Weight | kg |
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 | |
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 |
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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 |
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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 |
|
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 |
|
Part 11 Score |
|
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 |
|
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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