Record Sheets

English Books and Resources

This content is from pages 36 to 41 of Disabled Village Children

HealthWiki > Disabled Village Children > Chapter 4: Examining and Evaluating Children with Disabilities > Record Sheets

Below are the sample RECORD SHEETS. You are welcome to copy and use them. However, they are not perfect. They were developed for use by the village rehabilitation team in Mexico, and we are still trying to improve them. Before you make copies, we suggest that you adapt them to meet the needs of your area.

Be sure you have copies made of the RECORD SHEETS you will need before you need to use them.

In addition to the 4 RECORD SHEETS here, you may also want copies of RECORD SHEET 5 “Evaluation of Progress”, and RECORD SHEET 6, “Child Development Chart”.

Note on RECORD SHEET 1 (CHILD HISTORY):

The box at the top of RECORD SHEET 1 is to be filled out after you examine the child. It gives brief, essential information. This will make it easier to find out which disabilities you have seen most often, and to check on what you still need to do for different children.

The last few questions on page 2 of RECORD SHEET 1 are for a study PROJIMO is doing on medical causes of disability. Adapt them to study specific concerns in your area.

RECORD SHEET 1: CHILD HISTORY
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RECORD SHEET 2: PHYSICAL EXAM
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RECORD SHEET 3: ADDITIONAL TESTS AND OBSERVATIONS OF THE NERVOUS SYSTEM
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RECORD SHEET 4: FACTORS POSSIBLY AFFECTING CHILD DEVELOPMENT
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