UPDOX - PATIENT PORTAL

Patients Name * Date of Birth *

Communication and Language Skills

1. Indicates wants by pulling, pointing, or grunting * 2. Brings objects to you, such as a book to read * 3. Says 3-5 words (in addition to "mama" and "dada") and uses them correctly * 4. Can point to a body part when asked ("Where's your nose?") *

Movement and Physical Development

1. Takes steps without support * 2. Squats to pick something up * 3. Begins to accept liquids from a spouted or open cup * 4. Stacks three blocks * 5. Scribbles with crayon on paper *

Social and Emotional Development

1. Shows preference for certain activities (and will resist napping if engaged in a desired activity) * 2. Uses transitional objects (such as a blanket or stuffed animal) to self-comfort * 3. Has strong dislikes, such as fear of loud noises or bath time * 4. Shows affection to caregivers with hugs and kisses *

Cognitive Skills (Thinking and Learning)

1. Understands and follows simple commands * 2. Imitates activities, such as sweeping a floor * 3. Begins to engage in problem-solving activities, like simple puzzles * Signature of Parent/Guardian *