Has the child ever had any abnormality affecting the kidneys, bladder, or genital tract? Please ring more than one code, if appropriate.
Please examine the nose, throat, palate, pharynx and chest, and ring as appropriate.
Speech Test. (refer to 'Introductory Notes' before commencing test. Underline any mispronounced words and record the total. Test Sentences: The shop has run out of strawberry flavoured ice-cream. Stephen does not understand what the fuss is about. Gordon left his glasses on the chair. Perhaps Janet could fetch both of them. Carol screamed when she saw the spider on the couch. Total mispronounced words (e.g. for 8 enter 08)
Clinical Hearing Test. (See 'Introductory Notes' before commencing test.) Test Words Right Ear: Book Does Mouse Stick Three Pot Kind Field Hair Good Give Ball Train Had Big When Saw Can Last Poor Room Wash Floor One Said Enter total number of incorrect words, e.g. for 5 enter 05. Enter number
Have you the following records at your disposal now or when completing this form?
1 - Yes
2 - No
|Completed parental interview form|
|Infant Welfare Record|
|School Medical Record (Form 10M in England and Wales, School Medical Card in Scotland)|
UPPER RESPIRATORY SYSTEM
LOWER RESPIRATORY SYSTEM
UPPER AND LOWER RESPIRATORY TRACTS
ABDOMEN (including Uro-genital System)
By reference to the Introductory Notes and Instructions for the Medical Examination, assess the stages of pubertal development and record below the appropriate rating from one to five (e.g. for Stage 1 development enter 1 ); if unable to assess enter 0 and state reason below:
|Boys: Genitalia rating|
|Boys: Pubic hair rating|
|Girls: Breast rating|
|Girls: Pubic Hair rating|
LOCOMOTOR, SKELETAL AND CENTRAL NERVOUS SYSTEM
EYES AND VISION
MOTOR CO-ORDINATION TESTS
Age 11 Medical Examination