Sync template from atomicqms-style deployment

Forms/Screening-Results/FRM-SCR-001-Developmental-Screening-Summary.md

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+# Developmental Screening Summary Form
+
+| Form ID | FRM-SCR-001 | Revision | 1.0 |
+|---------|-------------|----------|-----|
+
+---
+
+## Section 1: Child Information
+
+| Field | Entry |
+|-------|-------|
+| Child Name | |
+| Date of Birth | |
+| Age at Screening | |
+| Medical Record Number | |
+| Screening Date | |
+| Screened By | |
+
+## Section 2: Parent/Guardian Information
+
+| Field | Entry |
+|-------|-------|
+| Parent/Guardian Name | |
+| Relationship to Child | |
+| Contact Phone | |
+| Email | |
+
+## Section 3: Screening Tool(s) Administered
+
+### Primary Screening Tool
+- [ ] ASQ-3 (Ages & Stages Questionnaires, 3rd Edition)
+- [ ] M-CHAT-R/F (Modified Checklist for Autism in Toddlers, Revised with Follow-Up)
+- [ ] PEDS (Parents' Evaluation of Developmental Status)
+- [ ] SWYC (Survey of Wellbeing of Young Children)
+- [ ] BRIGANCE Early Childhood Screens
+- [ ] Other: _______________
+
+### Screening Tool Version/Age Range
+| Tool | Version | Age Range |
+|------|---------|-----------|
+| | | |
+
+## Section 4: ASQ-3 Results (if applicable)
+
+| Domain | Raw Score | Cutoff Score | Status |
+|--------|-----------|--------------|--------|
+| Communication | | | ☐ Above ☐ Monitoring ☐ Referral |
+| Gross Motor | | | ☐ Above ☐ Monitoring ☐ Referral |
+| Fine Motor | | | ☐ Above ☐ Monitoring ☐ Referral |
+| Problem Solving | | | ☐ Above ☐ Monitoring ☐ Referral |
+| Personal-Social | | | ☐ Above ☐ Monitoring ☐ Referral |
+
+### Overall Concerns Section Results
+- [ ] No concerns indicated
+- [ ] Concerns noted: _______________
+
+## Section 5: M-CHAT-R/F Results (if applicable)
+
+### M-CHAT-R Initial Screening
+- Total Risk Items: _____ / 20
+- Critical Items: _____ / 6
+
+### Initial Risk Level
+- [ ] Low Risk (0-2 total)
+- [ ] Medium Risk (3-7 total)
+- [ ] High Risk (8-20 total)
+
+### Follow-Up Interview Conducted
+- [ ] Yes
+- [ ] No (not indicated)
+- [ ] Declined by family
+
+### Follow-Up Results (if conducted)
+- Final Score after Follow-Up: _____
+- [ ] Passed screening
+- [ ] Failed screening - referral recommended
+
+## Section 6: PEDS Results (if applicable)
+
+### Concerns Identified
+- [ ] No concerns
+- [ ] Predictive concerns (Path A)
+- [ ] Non-predictive concerns (Path B)
+- [ ] Low concerns (Path C)
+- [ ] No concerns but parent comment/question (Path D)
+- [ ] No concerns, no questions (Path E)
+
+### Recommended Path
+- [ ] Path A: Refer for diagnostic assessment
+- [ ] Path B: Screen further with developmental screening tool
+- [ ] Path C: Age-appropriate anticipatory guidance
+- [ ] Path D: Address specific question/concern
+- [ ] Path E: Continue routine surveillance
+
+## Section 7: Developmental Domains Assessed
+
+| Domain | Status | Notes |
+|--------|--------|-------|
+| Expressive Language | ☐ Typical ☐ Concern ☐ Delay | |
+| Receptive Language | ☐ Typical ☐ Concern ☐ Delay | |
+| Gross Motor | ☐ Typical ☐ Concern ☐ Delay | |
+| Fine Motor | ☐ Typical ☐ Concern ☐ Delay | |
+| Social-Emotional | ☐ Typical ☐ Concern ☐ Delay | |
+| Cognitive | ☐ Typical ☐ Concern ☐ Delay | |
+| Adaptive/Self-Help | ☐ Typical ☐ Concern ☐ Delay | |
+
+## Section 8: Red Flags Observed
+
+### Autism-Specific Red Flags
+- [ ] Limited eye contact
+- [ ] No response to name
+- [ ] Limited or no pointing
+- [ ] Limited social smiling
+- [ ] Unusual sensory interests
+- [ ] Repetitive behaviors
+- [ ] Other: _______________
+
+### General Developmental Red Flags
+- [ ] Loss of previously acquired skills
+- [ ] Significant delay in milestones
+- [ ] Concerns about hearing or vision
+- [ ] Asymmetric movements
+- [ ] Parental intuition of concern
+- [ ] Other: _______________
+
+## Section 9: Risk Factors
+
+- [ ] Prematurity (<37 weeks gestation: _____ weeks)
+- [ ] Low birth weight (<2500g: _____ g)
+- [ ] NICU admission
+- [ ] Family history of developmental disorders
+- [ ] Environmental risk factors (poverty, exposure)
+- [ ] Medical conditions affecting development
+- [ ] Other: _______________
+
+## Section 10: Overall Screening Result
+
+### Summary Result
+- [ ] Passed - Development appears typical
+- [ ] Monitoring - Some concerns, rescreening recommended
+- [ ] Failed - Referral for comprehensive evaluation recommended
+
+### Domains of Concern (if any)
+
+
+
+
+## Section 11: Recommendations and Referrals
+
+### Immediate Actions
+- [ ] Routine developmental surveillance at next well-child visit
+- [ ] Rescreening in _____ months
+- [ ] Referral for comprehensive developmental evaluation
+- [ ] Referral to Early Intervention (Part C Birth-to-Three)
+- [ ] Referral to Preschool Special Education (Part B)
+- [ ] Referral to specific services:
+  - [ ] Speech-Language Therapy
+  - [ ] Occupational Therapy
+  - [ ] Physical Therapy
+  - [ ] Audiology
+  - [ ] Ophthalmology
+  - [ ] Other: _______________
+
+### Referrals Made
+
+| Service/Provider | Referral Date | Contact Information |
+|-----------------|---------------|---------------------|
+| | | |
+| | | |
+
+### Parent Education Provided
+- [ ] Age-appropriate developmental milestones discussed
+- [ ] Activities to promote development reviewed
+- [ ] Resources provided (handouts, websites, community programs)
+- [ ] Follow-up plan explained
+
+## Section 12: Parent Communication
+
+### Discussion with Parent/Guardian
+- Screening results explained: ☐ Yes
+- Questions answered: ☐ Yes
+- Recommendations discussed: ☐ Yes
+- Written summary provided: ☐ Yes
+
+### Parent Response
+- [ ] Agrees with recommendations
+- [ ] Has questions (documented below)
+- [ ] Declines recommendations
+- [ ] Requests additional information
+
+### Notes
+
+
+
+
+## Section 13: Follow-Up Plan
+
+| Follow-Up Action | Responsible Person | Target Date |
+|------------------|-------------------|-------------|
+| | | |
+| | | |
+
+## Section 14: Signatures
+
+| Screener Signature | | Date | |
+|-------------------|---|------|---|
+| Reviewed By (Provider) | | Date | |
+| Parent Acknowledgment | | Date | |
+
+---
+
+*Form FRM-SCR-001 Rev 1.0*