Opinion ID: 4387846
Heading Depth: 3
Heading Rank: 1

Heading: CIWA-Ar

Text: This assessment was in the form of a scoresheet broken up into 10 different categories, each scored on a scale beginning “0,” as the least severe. For instance, the first box concerned “[n]ausea and vomiting,” with the following questions: “Do you feel sick to the stomach? Have you vomited?” Kohl Dep., R. 109-3, Page ID # 823–25; 863–66 (citing LMDC Medical Record, R. 54-7, Page ID # 344). Depending upon the answer, the box included suggested scores. At the 5 Case No. 18-5224, Blaine v. Louisville Metro. Gov’t bottom of the box was a line in which the assessor marked the score. Here, Cross scored a “0.” Id. The next box concerned “[t]actile disturbances,” with the following questions: “Have you any itching, pins and needles sensations, burning, numbness, or do you feel bugs crawling on or under your skin?” Id. Again, Kohl scored Cross a “0.” Id. Other boxes concerned “[t]remor[s],” “[a]uditory hallucinations,” “[p]aroxysmal sweats,” “[v]isual disturbances,” “[a]nxiety,” “[h]eadache, fullness in head,” “[a]gitation,” and “[o]rientation and clouding of sensorium.” Id. Kohl went through each section of the assessment with its various questions and scored Cross a zero for each section; thus, ultimately, Kohl determined that Cross’s total CIWA-Ar score was zero. The form stated, “< 10 points = Mild/at risk (Recheck as ordered).” Id. The other parts of the form stated, “10-15 points = Moderate (Notify provider)[.] Medication may be indicated” and “> 15 points = Severe (Notify provider immediately)[.] Medication may be [i]ndicated.” Id. Kohl signed the form at 5:06 PM.