Alert and oriented x4 usually describes someone who is awake, responds to their surroundings and correctly identifies who they are, where they are, the time or date, and their situation. The number four refers to those areas of orientation. It is not a score for all brain functions.
A question might ask why the person is in hospital or receiving care. This is an example, not a record of the exact question asked during a particular examination.
Yes. Those abilities need separate assessment. The note describes alertness and orientation at the time of the examination; it does not establish that every other thinking ability is normal.

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