Specify if the patient has ever had any of the following conditions:
Stroke? – Select Yes or No.
With Yes selected, a set of responses (Date and Description) is available.
For each additional set of responses you want to add, click Add More. You can add up to four additional sets of responses.
Note: To delete an additional set of responses, click the corresponding Delete button 
.
Optionally, select a year and/or description for each set of responses:
Date - Select a year or Unknown. If a year is selected, to specify that the year is approximate, select the Approximate Date checkbox.
Description - Select one of the following descriptions:
Stroke (Unknown type).
Ischemic Stroke.
Hemorrhagic Stroke.
Cryptogenic Stroke.
Transient Ischemic Attack (TIA).
Residual Deficits: Right Side.
Residual Deficits: Left Side.
Residual Deficits: Both Sides.
Residual Deficits: None.
Other – With this option selected, an Add description box is available. Optionally, enter up to 60 characters.
Epilepsy, seizures, multiple sclerosis or a nervous system disorder? – Select Yes or No.
With Yes selected, a set of responses (Date and Description) is available.
For each additional set of responses you want to add, click Add More. You can add up to four additional sets of responses.
Note: To delete an additional set of responses, click the corresponding Delete button .
Optionally, select a year and/or description for each set of responses:
Date - Select a year or Unknown. If a year is selected, to specify that the year is approximate, select the Approximate Date checkbox.
Description - Select one of the following descriptions:
Epilepsy.
Multiple Sclerosis.
Seizures.
Status Epilepticus (History of).
Alzheimer's Disease.
Dementia.
Parkinson’s Disease.
Paresthesia (Numbness).
Bell's Palsy.
Migraine Headaches.
Other – With this option selected, an Add description box is available. Optionally, enter up to 60 characters.