Get the free CEREBRAL PALSY DESCRIPTION FORM Part I MOTOR IMPAIRMENTS - kemh health wa gov

CEREBRAL PALSY DESCRIPTION FORM Child's name: DOB: Please attach sticky label if available Part I: MOTOR IMPAIRMENTS Examining clinician: 2. Describe face/ 1. Is there spasticity in one or more limbs?

How to fill out cerebral palsy description form

How to fill out cerebral palsy description form:

1. Begin by carefully reading through the form, making sure to understand each section and what information is required.
2. Start by providing your personal details, such as your name, contact information, and any relevant identification numbers.
3. Next, provide an overview of the individual with cerebral palsy, including their name, date of birth, and any other identifying information.
4. Proceed to fill out the medical history section, providing details about the diagnosis, the date of diagnosis, and any underlying conditions related to cerebral palsy.
5. In the functional capabilities section, describe the individual's abilities and limitations in terms of mobility, communication, self-care, and any other relevant areas.
6. Provide information about any treatments, therapies, or medications that the individual with cerebral palsy is currently receiving or has undergone in the past.
7. If applicable, include details about any assistive devices or equipment that the individual uses to aid in mobility or daily living activities.
8. In the education section, describe any specialized education programs, interventions, or accommodations that the individual requires or has received.
9. Finally, review the completed form to ensure all sections are accurately filled out and check for any missing information or errors before submitting it.

Who needs cerebral palsy description form:

The cerebral palsy description form is typically required for individuals who have been diagnosed with cerebral palsy or who are seeking services, support, or accommodations related to their condition. This may include parents or caregivers filling out the form on behalf of a child or a person with cerebral palsy completing the form for themselves. Medical professionals, educators, and service providers may also require this form to assess and understand the individual's needs in order to provide appropriate care, therapies, or interventions.

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