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Program Information. Child ID #: Program ID #: Program name: Age at administration in months and days: If premature, adjusted age in months and days: 18 Month Questionnaire 17 months 0 days through 18 months 30 days. On the following pages are questions about activities babies may do.
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Apr 18, 2022 · 18 MONTH ASQ.pdf. TEHDI. Texas Early Hearing Detection and Intervention. HEARING CHECKLIST FOR PARENTS. STAGES OF HEARING, LANGUAGE, AND SPEECH DEVELOPMENT FROM BIRTH TO 5 YEARS CHECKLIST. Please use this checklist! Look at your checklist often. Find your child’s age level.
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May 3, 2017 · The master set (“Master Set.pdf”) includes in a single PDF file all ASQ-3 questionnaires, cover sheets (family information sheets) in data template format, scoring sheets (Information Sum- mary sheets), intervention activities, and supplemental materials.
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Mar 31, 2020 · o ASQ-TRAK questionnaires need to be administered jointly with the clinician and family by interview only, encouraging demonstration of each item o Culturally appropriate items and draw on materials. • Screening ages for the ASQ-TRAK are; 2 months, 6 months, 12 months, 18 months, 24 months, 36 months and 48 months.
18 Month Questionnaire. (For children ages 15 through 20 months) Important Points to Remember: Please return this questionnaire by . If you have any questions or concerns about your child or about this questionnaire, please call: Thank you and please look forward to filling out another ASQ:SE questionnaire in months.
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person filling out the ASQ: Mailing address: Telephone: Today's date: 18 Month ASQ Information Summary Date of birth: Corrected date Of birth: Relationship to child: Assisting in ASO completion: OVERALL: Please transfer the answers in the Overall section of the questionnaire by circling "yes" or "no" and reporting any comments. 3. 4. Hears well?
The ASQ-3 Starter Kit contains everything you need to start screening children with ASQ-3: 21 paper masters of the questionnaires and scoring sheets, a CD-ROM with printable PDF questionnaires, the ASQ-3 User’s Guide, and a FREE ASQ-3 Quick Start Guide.
