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Autism Assessment Clinic

Medical Examination Report

Autism Assessment Clinic – Medical Examination Report

Step 1 of 7

Background

Completed by the Paediatrician at the medical examination appointment.

Physical Examination

Cardiac Murmur
Respiratory Assessment
Dysmorphic Features evident
Neurocutaneous markings i.e. cafe au lait spots/axillary freckles
Strabismus
Wears glasses
Cataract
Hearing normal
Abdominal organomegaly evident
Peripheral Power
Co-ordination of movement
Peripheral reflexes
Spine

Overall impression

Discussed with parents

Recommendations

Paediatrician name and Signature

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