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D5 NICHQ Vanderbilt Assessment Follow-up PARENT Informant Today s Date Child s Name Date of Birth Parent s Name Parent s Phone Number Directions Each rating should be considered in the context of what is appropriate for the age of your child. Variations taking into account individual circumstances may be appropriate. Please return this form to Mailing address Fax number Scoring Instructions for the NICHQ Vanderbilt Assessment Scales These scales should NOT be used alone to make any diagnosis....
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