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Complete Packet- 18 months

18 month Developmental

At this age, many toddlers may not be cooperative when asked to do things. You may need to try the following activities with your child more than one time. If possible, try the activities when you chid is cooperative. If you child can do the activity but refuses, mark "yes" for the item.

Communication

Provide example below

Gross Motor

Fine Motor

Problem Solving

Personal-Social

Overall

MCHAT- toddler autism screening

Please fill out the following about how your child usually is. Please try to answer every question. If the behavior is rare (e.g., you've seen it once or twice), please answer as if the child does not do it.

Bright Futures- how is your child doing?

We are interested in answering your questions. Please check off the boxes for the topics you would like to discuss the most today.

Yes
No

Lead Risk Assessment

TB Risk Assessment

If yes, to any of the above, the child has and increased risk of TB infection and should have a TST/IGRA. All children with a positive TST/IGRA result must have a medical evaluation, including a chest X-ray. Treatment for latent TB infection should be initiated if the chest X-ray is normal and there are no signs of active TB. If testing was done, please attach or enter results on next page.

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