II. SCHOOL HISTORY a. EARLY INTERVENTION SAMPLE Early Intervention Record Review Physical (fine and Developmental gross motor, Cognition Adaptive behavior Communication Social-emotional Other concerns Domains: sensory processing) Initial AE: 15 AE:14 GROSS MOTOR AE: 10 AE: 15 Developmental MD: 0 MD:1 AE:16 MD: 5 MD: 0 Evaluation %D: 0 %D: 6 MD: 0 %D:33 %D: 0 Date: 6/28/00 Identified Needs: %D: 0 Identified Needs: CA: 15 Not yet FINE MOTOR doesn’t point to Tool used: cooperating during AE:14 objects when Bailey dressing. MD:1 named %: 6 Identified Needs: Not using a spoon to feed. SL N/A N/A N/A RECEPTIVE N/A None Assessment AE: 11 Date: 7/3/00 MD: 4 CA: 15 %: 26 Tool used: Identified REEL-3 doesn’t point to body parts EXPRESSIVE AE: 9 MD: 6 %: 33 Identified needs: doesn’t babble in sentence like intonation Outcomes: Initial IFSP
II. SCHOOL HISTORY a. EARLY INTERVENTION SAMPLE Early Intervention Record Review Developmental Domains: Cognition Adaptive behavior Physical (fine and gross motor, sensory processing) Communication Social-emotional Other concerns Initial Developmental Evaluation Date: 6/28/00 CA: 15 Tool used: Bailey AE: 15 MD: 0 %D: 0 AE:14 MD:1 %D: 6 Identified Needs: Not yet cooperating during dressing. GROSS MOTOR AE:16 MD: 0 %D: 0 FINE MOTOR AE:14 MD:1 %: 6 Identified Needs: Not using a spoon to feed. AE: 10 MD: 5 %D:33 Identified Needs: doesn’t point to objects when named AE: 15 MD: 0 %D: 0 SL Assessment Date: 7/3/00 CA: 15 Tool used: REEL-3 N/A N/A N/A RECEPTIVE AE: 11 MD: 4 %: 26 Identified doesn’t point to body parts EXPRESSIVE AE: 9 MD: 6 %: 33 Identified needs: doesn’t babble in sentence like intonation N/A None Initial IFSP Outcomes: