Get Case History Form To Fill Out For Children With Auditory Processing Disorder

Filling out the Case History Form for children with auditory processing disorder is an essential step in seeking the necessary support and intervention. This guide provides step-by-step instructions to help you successfully complete the form online.

Follow the steps to effectively complete the form.

1. Press the ‘Get Form’ button to access the form and open it in your browser.
2. Begin by entering the identifying information. Fill in the date, the child’s full name, address, phone numbers, date of birth, and age. Ensure accuracy, as this information is crucial for tracking the child's progress.
3. Complete the referral source section by providing the name and address of the individual or entity that referred the child for evaluation. Include the primary care physician’s information as well.
4. In the family background section, you’ll need to input details about the child's parents and siblings, including their names, ages, and occupations. This helps in understanding the family dynamics and potential hereditary factors.
5. Describe the statement of the problem clearly. Explain when the problem was first noticed, who identified it, and if there is a family history of similar issues.
6. Fill out the medical history by indicating the child's current health status and providing information about their birth history, including pregnancy and delivery details, along with newborn hearing screening outcomes.
7. Indicate developmental milestones by checking the appropriate boxes for skills such as fine motor skills, gross motor skills, and speech and language skills.
8. Document any health issues encountered by the child, particularly related to hearing or ear conditions. Provide dates and details for any significant medical events, including treatments.
9. In the professional diagnosis section, check any relevant disorders the child has been diagnosed with and provide information about the professionals who made these diagnoses.
10. List any medications the child is currently taking, both prescription and non-prescription. Include the prescribing physician, dosage, and purpose for clarity.
11. Provide academic history, including the name and address of the school, current grade, teacher’s name, and classroom setting. Explain any academic difficulties and the support services the child receives.
12. Indicate any evaluations completed regarding the child’s learning and behavioral health, checking the applicable types of assessments.
13. Describe specific academic challenges the child faces at home and in school, using clear examples to illustrate each difficulty encountered.
14. Add any additional information that may be beneficial for the child’s assessment and care. This could include social factors, emotional well-being, or other relevant observations.
15. Finally, provide the names and addresses for where you would like the report sent. Ensure that you sign the document and date it.
16. After completing all sections, save your changes, and consider downloading, printing, or sharing the form as needed.

Complete the Case History Form online today to ensure your child receives the support they need.