VICTORIAN EARLY ASSESSMENT CLINIC
Olga Tennison Autism Research Unit
Child’s Name (Date of Birth: xxx) Age at assessment: xxx
Mailing address
Dr Melissa Gilbert
ASD Assessment Specialist
Victorian Early Assessment Clinic Olga Tennison Autism Research Unit La Trobe University
Bundoora
Victoria 3086 Australia
T +61394790000
E [email protected]
CHILD was seen on DATE, at … as part of …. The visit included and assessment of …, …, … and … with ….
Heading…
Test Name… was used to assess …
Scale Name. This scale measures … CHILD’s performance was equivalent to…. This means…
Scale Name. This scale measures … CHILD’s performance was equivalent to…. This means…
Scale Name. This scale measures … CHILD’s performance was equivalent to…. This means…
Overall, Child’s skills for … are …. He performed better than other children in …. By contrast, he performed more poorly than… This might be due to…
Heading…
Test Name… was used to assess …
Despite being unwell on the day, child engaged well in the assessment activities. He did… and … well. By contrast, he has difficulty with … and was not seen to do …. (Summary of things in key area/s targeted by the assessment)
Overall, child’s skills appear to be … The child’s score reached cutoff for …
Heading…
Child’s … skills were also assessed using … completed by his parent, ….
Parent reported that child is the middle of three children. He is …. He attends…. She describes him as …. Child seems to understand… but have difficulty with ….
ABN 64 804 735 113
CRICOS Provider 00115M
VICTORIAN EARLY ASSESSMENT CLINIC
Olga Tennison Autism Research Unit
Mailing address
Dr Melissa Gilbert
ASD Assessment Specialist
Victorian Early Assessment Clinic Olga Tennison Autism Research Unit La Trobe University
Bundoora
Victoria 3086 Australia
T +61394790000
E [email protected]
There are clear concerns for parent with …. He achieved … milestones as expected but …. There has never been any reported…
Despite being unwell on the day, child engaged well in the assessment activities. He did… and … well. By contrast, he has difficulty with … and was not seen to do …. (Summary of things in key area/s targeted by the assessment)
Summary of things in key area/s targeted by the assessment)
The behaviour reported for child by … suggests… The child’s score reached cutoff for … Heading…
In summary, child was … at the assessment appointment/s. (Summary of observations, parent report, strengths and challenges). This suggests … (clear conclusion/answer to referral question).
Name
Title/Role Organisation
2/2
VICTORIAN EARLY ASSESSMENT CLINIC
Olga Tennison Autism Research Unit
Child’s Name (Date of Birth: xxx) Age at assessment: xxx
Mailing address
Dr Melissa Gilbert
ASD Assessment Specialist
Victorian Early Assessment Clinic Olga Tennison Autism Research Unit La Trobe University
Bundoora
Victoria 3086 Australia
T +61394790000
E [email protected]
CHILD was seen on DATE, at … as part of …. The visit included and assessment of …, …, … and … with ….
Heading…
Test Name… was used to assess …
Scale Name. This scale measures … CHILD’s performance was equivalent to…. This means…
Scale Name. This scale measures … CHILD’s performance was equivalent to…. This means…
Scale Name. This scale measures … CHILD’s performance was equivalent to…. This means…
Overall, Child’s skills for … are …. He performed better than other children in …. By contrast, he performed more poorly than… This might be due to…
Heading…
Test Name… was used to assess …
Despite being unwell on the day, child engaged well in the assessment activities. He did… and … well. By contrast, he has difficulty with … and was not seen to do …. (Summary of things in key area/s targeted by the assessment)
Overall, child’s skills appear to be … The child’s score reached cutoff for …
Heading…
Child’s … skills were also assessed using … completed by his parent, ….
Parent reported that child is the middle of three children. He is …. He attends…. She describes him as …. Child seems to understand… but have difficulty with ….
ABN 64 804 735 113
CRICOS Provider 00115M
VICTORIAN EARLY ASSESSMENT CLINIC
Olga Tennison Autism Research Unit
Mailing address
Dr Melissa Gilbert
ASD Assessment Specialist
Victorian Early Assessment Clinic Olga Tennison Autism Research Unit La Trobe University
Bundoora
Victoria 3086 Australia
T +61394790000
E [email protected]
There are clear concerns for parent with …. He achieved … milestones as expected but …. There has never been any reported…
Despite being unwell on the day, child engaged well in the assessment activities. He did… and … well. By contrast, he has difficulty with … and was not seen to do …. (Summary of things in key area/s targeted by the assessment)
Summary of things in key area/s targeted by the assessment)
The behaviour reported for child by … suggests… The child’s score reached cutoff for … Heading…
In summary, child was … at the assessment appointment/s. (Summary of observations, parent report, strengths and challenges). This suggests … (clear conclusion/answer to referral question).
Name
Title/Role Organisation
2/2
VICTORIAN EARLY ASSESSMENT CLINIC
Olga Tennison Autism Research Unit
Child’s Name (Date of Birth: xxx) Age at assessment: xxx
Mailing address
Dr Melissa Gilbert
ASD Assessment Specialist
Victorian Early Assessment Clinic Olga Tennison Autism Research Unit La Trobe University
Bundoora
Victoria 3086 Australia
T +61394790000
E [email protected]
CHILD was seen on DATE, at … as part of …. The visit included and assessment of …, …, … and … with ….
Heading…
Test Name… was used to assess …
Scale Name. This scale measures … CHILD’s performance was equivalent to…. This means…
Scale Name. This scale measures … CHILD’s performance was equivalent to…. This means…
Scale Name. This scale measures … CHILD’s performance was equivalent to…. This means…
Overall, Child’s skills for … are …. He performed better than other children in …. By contrast, he performed more poorly than… This might be due to…
Heading…
Test Name… was used to assess …
Despite being unwell on the day, child engaged well in the assessment activities. He did… and … well. By contrast, he has difficulty with … and was not seen to do …. (Summary of things in key area/s targeted by the assessment)
Overall, child’s skills appear to be … The child’s score reached cutoff for …
Heading…
Child’s … skills were also assessed using … completed by his parent, ….
Parent reported that child is the middle of three children. He is …. He attends…. She describes him as …. Child seems to understand… but have difficulty with ….
ABN 64 804 735 113
CRICOS Provider 00115M
VICTORIAN EARLY ASSESSMENT CLINIC
Olga Tennison Autism Research Unit
Mailing address
Dr Melissa Gilbert
ASD Assessment Specialist
Victorian Early Assessment Clinic Olga Tennison Autism Research Unit La Trobe University
Bundoora
Victoria 3086 Australia
T +61394790000
E [email protected]
There are clear concerns for parent with …. He achieved … milestones as expected but …. There has never been any reported…
Despite being unwell on the day, child engaged well in the assessment activities. He did… and … well. By contrast, he has difficulty with … and was not seen to do …. (Summary of things in key area/s targeted by the assessment)
Summary of things in key area/s targeted by the assessment)
The behaviour reported for child by … suggests… The child’s score reached cutoff for … Heading…
In summary, child was … at the assessment appointment/s. (Summary of observations, parent report, strengths and challenges). This suggests … (clear conclusion/answer to referral question).
Name
Title/Role Organisation
2/2