Packet for patients five years of age and older - Atlantic Health System
Packet for patients five years of age and older - Atlantic Health System
Packet for patients five years of age and older - Atlantic Health System
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COORDINATION<br />
Approximately rate your child’s developmental history on the following skills with a check mark:<br />
Above Aver<strong>age</strong> Aver<strong>age</strong> Poor Not doing<br />
yet<br />
Walking<br />
Running<br />
Throwing<br />
Catching<br />
Scribbling with a<br />
crayon/writing<br />
Self feeding<br />
Making a block<br />
tower/Legos<br />
Self-dressing<br />
Excessive number<br />
<strong>of</strong> accidents<br />
compared to other<br />
children (specify)<br />
Do you have any concerns about your child’s motor development? Yes / No_________________<br />
Has your child ever been evaluated by a Physical Therapist? Yes / No______________________<br />
Has your child ever been evaluated by an Occupational Therapist? Yes / No_________________<br />
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