Pediatric Occupational & Physical Therapy ... CHILD MEDICAL HISTORY FORM Date: Thank you for scheduling your child's evaluation at St. |
The checklist supports high quality occupational therapy evaluations that lead to occupation-based, client centered interventions, and quality performance ... |
The information on the form allows the occupational therapist to tailor the assessment activities to your child, prior to your appointment. |
Unable to form letters or numbers. Demonstrates established hand dominance (right). • Bilateral coordination: Emma is able to string several medium (1” size) ... |
In order to provide a comprehensive evaluation of your child, we request that you take a few minutes to fill in the following questionnaire as accurately as ... |
All sections must be completed. SPEECH THERAPY ASSESSMENTS ONLY. Language evaluations: should include oral-mechanism examination and objective assessment of ... |
©Salus Occupational Therapy Institute 2021. 1. Pediatric Intake Form ... ©Salus Occupational Therapy ... When was your last comprehensive medical evaluation? |
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