— —_—_ ‘enits Name 1s start Dato 05/24/16 Description of Child ~ Present Level of Development (information required for each domain) Other Data Sources Rohatek Parent/Caregiver Input Development satentCaresiver. nou (Observation, Evaluation Results, Medical Records, ete.) HEBD» 0ve5 his hands and toys to his mouth. He {MiilBMurns his head to look for noises and Cognitive - looks back and forth between two objects and | visually folows odjects. He explores toys with ‘Thinking and learning (2x, tok for dropped toy; pull toy on a sting; doa Sinple puzte). brielly looks at pictures in books. He experimonts {to find out what happens when he throws, drops, shakes or bangs objocts. He shows curiosity as he explores his surroundings. his mouth and eyes and shakes and bangs them against other toys. He pokes al buttons to cause sounds and lights on toys BRS not yet looking for objects dropped out of sight. ‘Communication - Expressive/Receptive (x, startle a loud notses; ‘makes sounds; understands sounds, mords, gestures and talking; uses two or more word sentences; points 0 desired object). startled by loud noises and he turns 0 See where a sound is coming from. He ‘squeals, shrieks and makes loud noises. He ‘gurgles when he is happy and practices ‘making sounds with his mouth when he is alone. ks toward people whon they talk to nim, He mimios puckered lips and smiles ‘and engages in vocal exchanges by cooing “ooh and mum." He babbles and makes raspberries. He is not yet looking when his ‘name is called or using a variety of sounds. Physical - (Gots & Fine Motor/Sensory (ex., reach for and play with toes; st, ol, crawl; throw a ‘mma ball thread cord through targe bead). [Qc ands ger wien yg nie Daekand iss hie hoad and host off he for whan ents trnny, He ole rom his back to tamy ae tummy fo beck He a vthout supa or short ports of timo and palo to stared wale hong onto Caregiver ngors. ie uses hs fagors and hands fo contol and manipulate obj, ses his fingers and palm to grasp small toys and food. He sits without suppor, rolls to get toys and pulls to sit and stand. He is not yet catching himself with his hands or pulling himself forward to reach toys. Social/Emotional - Imeracting with others (x, smile and coo; pull on Your hand or clothes to gah ‘attention; share @ toy; take turns with others). EBB aryng when tata to, poked up or comforted. Ho expresses feclngs such as anger, exciloment or hunger. He enjoy paving peekarboo, hugs, cuddles and totes. He oOks eways to get caregiver’ allerton and he can 90 Tor long periods of te without ening. alms to mom's voice and when she > him up. He gives kisses and smiles and makes eye contact to gain attention ‘when interacting with people. He sucks on his fingers to self-soothe and ories to let mom know he is hungry, tied or upset. Adaptive - Feeding, eating, dressing, and sleeping (e, help hold a bottle; ‘each fora toy; help dress bath time very much, He sleeps for 14-16 out of a 24 hour period and takes two naps a day. Ho ‘feeds himeolt small pieces of food and is starting to bring grab the spoon and bring ito his mouth. @: to hold a smal bot and he forms 2 ats soft food from a spoon and fight seal around a nipple when sucking. He enjoys feeds himself finger f ie is starting to hold his own Sc ys the bath. He sleeps 11-12 hours at night ‘and takes 2 naps during the day. tinsel or hetel Vision/Hearing Screenings (Check those that apply) Vision Hearing Concern YO] N fill Concern YC] NI ‘Screening Requested ("] Screening Results: [x] Passed Date of Screening: Screening Completed B Follow Up Needed: al Newborn or Other Screening Requested [] Newborn or Other Screening Results: [x] Passed ["] Referred Date of Screening: 03/08/15 Screening Competed By: Doct Follow Up Needed: LJ Referred dane infant Tosdles Program Date Completed: 05/24/16 Indviduakzed Family Service Plan ~ May 2015,