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  • Assessment Form

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    Blue House
    12 views7 pages
    This document contains sections to record a child's history, including educational, medical, developmental background. It includes areas to note physical and sensory examinations, motor skills, communication, activities of daily living. Parents' concerns and recommendations are documented. The form is used to assess a child's overall functioning by a professional at Blue House-Tigoni.

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    This document contains sections to record a child's history, including educational, medical, developmental background. It includes areas to note physical and sensory examinations, motor skills, communication, activities of daily living. Parents' concerns and recommendations are documented. The form is used to assess a child's overall functioning by a professional at Blue House-Tigoni.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    12 views7 pages

    Assessment Form

    Uploaded by

    Blue House
    This document contains sections to record a child's history, including educational, medical, developmental background. It includes areas to note physical and sensory examinations, motor skills, communication, activities of daily living. Parents' concerns and recommendations are documented. The form is used to assess a child's overall functioning by a professional at Blue House-Tigoni.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 7

    History

    Educational background

    Personal/Social History

    Medical History
    Antenatal History

    Post-Natal

    Current Medical Condition


    Physical Examination
    Sensory integration

    Vestibular Function

    Tactile Sensation

    Auditory Function

    Gustatory
    Vision

    Olfactory

    Proprioception

    Motor Function
    Activity Level

    Behaviour/Mannerisms

    Communication & Social Skills


    Speech and Language
    Interests/Interaction

    Activities of Daily Living


    Self-Care Activities
    Toileting

    Bathing

    Dressing and Grooming

    Feeding
    Instrumental Activities of Daily Living
    Is he/she able to operate any appliances? If so, please list them

    Motor Function
    Fine Motor Skills

    Gross Motor Skills

    Imaginative Skills

    Awareness
    Awareness of danger

    Awareness of the surrounding environment


    Parents’ concerns

    Recommendations

    Assessed by: ……………………………………………………………………

    Date: ………………………………………………………………………………
    BLUE HOUSE- TIGONI
    ASSESSMENT FORM

    Name of child

    D.O.B

    Sex

    Parent’s/ Guardian’s Name

    Telephone number

    Email address:

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