Forms Cabinet & Clinic Tools

Pre-Rotation Forms

Dev Peds/Peds Rehab Learner Availability Form - please complete at least 2 weeks prior to rotation start date.

End of Rotation Survey- please complete prior to the end of your rotation and save for your records.

Consult Template and Report Writing

Here is a blank template for a comprehensive assessment that you can download and adapt to your needs.

(looks oddly formatted until you fully download it into word -- then you can edit it for your preferences).

Here are some options for quick "profile sheets" where you can gather your thoughts/chart review prior to a clinic, if helpful for you:

Here is Dr. Lemieux's "What does a done clinic report look like?" checklist.

The Pocket Guide

Virtual Autism Assessments & the AAPLES Tool

AAPLES TOOL:

Forms

Assorted Clinic Tools

Autism Assessment Tools

Here is a template you can use during Autism assessments to organize your thoughts and questions: Dr. Lemieux's IPAS Clinical Observation Record
There are photocopies of ADOS protocols in the resident office (or can be printed from this link: Full ADOS modules for co-scoring) -- please take one to follow along if you are watching an ADOS.
Some clinics will use shorter variations on this such as the "mini" ADOS (forms linked below) or the AAPLES (Autism Assessment for Preschoolers with Language Element Sequence).

Follow the Child observations of multidisciplinary assessments:
- This is the follow the child information sheet and observation record that can be used in many clinics, mainly in the Northern Neonatal Follow-Up Clinic, where you will see multidisciplinary assessments for a child in clinic (such as cognitive development, audiology, OT, PT, dietitian).

Daycare Observations:

Developmental Observation record for use in daycare observations

The Hammersmith Infant Neurological Examination (HINE)

Assessment form with scoring guide
- Assessment form adjusted with U of A angle references
Clinical fact sheet
Hammersmith Neurological Examinations (videos)

Maximizing Clinical Learning

When you’re presenting a case, use the SNAPPS to get the most out of your learning (in ≤ 5 minutes!). Ask your preceptor to use the OMP, when you want to learn a tip transferrable to future similar cases.

Crucial skills Developmental Attainments charts

Crucial skills – Infant Toddler *
Crucial skills – Early Childhood *
Crucial skills – School Age *
Crucial skills with prompts – First Six Years *
Crucial skills with prompts – School Age *

*Denotes tables pending.

Online access: Crucial skills charts can be accessed through https://www.pedscases.com
Connect Care access: Crucial skills charts can be accessed using the smart phrase .grhcrucial

Comprehensive Developmental Attainments Charts

Comprehensive First Six Years Developmental Attainments chart

Comprehensive School Age Developmental Attainments chart
1. Comprehensive_Middle Childhood (6,7,8 Years) Developmental Attainments *
2. Comprehensive_Academic Skills - Middle Childhood Developmental Attainments *
3. Comprehensive_Late Childhood (9,10,11,12 Years) Developmental Attainments *
4. Comprehensive_Academic Skills - Late Childhood Developmental Attainments *
5. Level of evidence, percentile, and age row placement in comprehensive School Age Developmental Attainments chart *
6. References for comprehensive School Age Developmental Attainments chart *

*Denotes tables pending

What does that stand for?!

Common assessment measures used in Dev Peds, and their acronyms