Does
																																																												patient
																																																												have
																																																												history
																																																												of
																																																												swallowing
																																																												problems? | 
																																								Yes/No | 
																				
																				
																																								  
																																																												Does
																																																												patient
																																																												have
																																																												a
																																																												history
																																																												of
																																																												pneumonia? | 
																																								Yes/No | 
																				
																				
																																								  
																																																												Does
																																																												the
																																																												patient
																																																												take
																																																												longer
																																																												than
																																																												three
																																																												seconds
																																																												to
																																																												swallow? | 
																																								Yes/No | 
																				
																				
																																								  
																																																												Does
																																																												patient
																																																												still
																																																												have
																																																												food
																																																												remaining
																																																												in
																																																												mouth
																																																												after
																																																												several
																																																												attempts
																																																												to
																																																												swallow? | 
																																								Yes/No | 
																				
																				
																																								  
																																																												Does
																																																												the
																																																												patient
																																																												appear
																																																												to
																																																												choke,
																																																												gag
																																																												or
																																																												cough
																																																												when
																																																												swallowing
																																																												thin
																																																												liquids
																																																												or
																																																												solid
																																																												food? | 
																																								 Yes/No | 
																				
																				
																																								  
																																																												Does
																																																												the
																																																												patient
																																																												take
																																																												several
																																																												attempts
																																																												to
																																																												swallow? | 
																																								Yes/No | 
																				
																				
																																								  
																																																												Does
																																																												the
																																																												patient
																																																												seem
																																																												to
																																																												pocket
																																																												food
																																																												on
																																																												either
																																																												side
																																																												of
																																																												his
																																																												mouth? | 
																																								Yes/No | 
																				
																				
																																								  
																																																												Does
																																																												the
																																																												patient
																																																												drool
																																																												wither
																																																												at
																																																												rest
																																																												or
																																																												after
																																																												taking
																																																												a
																																																												drink? | 
																																								Yes/No | 
																				
																				
																																								  
																																																												Does
																																																												the
																																																												patient
																																																												have
																																																												a
																																																												wet,
																																																												gurgly
																																																												to
																																																												his/her
																																																												voice
																																																												before
																																																												or
																																																												after
																																																												swallowing? | 
																																								Yes/No | 
																				
																				
																																								  
																																																												Does
																																																												the
																																																												patient
																																																												have
																																																												rales
																																																												or
																																																												rhonchi
																																																												upon
																																																												auscultation? | 
																																								Yes/No |