DHS-381, Well Child Exam Middle Childhood: 6-10 Years
Validated Standardized Behavioral Screening completed: Date Screener Used: Pediatric Symptom Checklist (PSC) PEDS PEDSDM (PEDS/DM may be used Until the child turns 8 years old) Other tool: Score: Referral Needed: No Yes Referral Made: No Yes Date of Referral: Agency: Current or Past Mental Health Services Received: No Yes (if yes please provide ... ................
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