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Supplemental Emotional indicators Record/Form Section 1. Identifying Information Name Motor impairment Yes No C1 Female] Male Grade —____ Type Yea Month Day——_Langunge Spoken Date Tested eee ay ay SS Scoot Date of ith pa as Se Hn Beer Nee, Age ——— — —_ aariners tte Section 2. Observational Notes and Interpretation Observational Notes Preliminary Interpretive Surnmary Benes restate Hogho fin Canpany anid th pemsson orl cones hs form 25] may ephedra £1007 ROD Fe "ODA Sha ie Ast TAH Trsas 67690 Wo wo B70 Fa 163 pone Section 3. Scoring of Presence or Absence of the Koppitz Emotional Indicators {See Chapter7of the KOPPIZ-2 Examines Manual fr detaled criteria scoring examples) Scoring Criteria 1. Confused Order Designs are scattered arbitrary on paper thou logical sequence or order. Confused orders not scored inthe presence of any sort of ede or logical sequence. This may include arrangements fom top of page

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