Reprinted from Down Syndrome Quarterly, Volume 4, Number 3, September, 1999

Down Syndrome Health Care Guidelines (1999 Revision) Record Sheet

Sheet #2:  13 Years to Adulthood


Name: ________________________________         Birthday: ____________________________
 
Age, in years
Medical Issues 13 14 15 16 17 18 19 20-29
Usual Preventative
Care
___ ___ ___ ___ ___ ___ ___ ___
Audiologic
Evaluation
___ ___ ___ ___ ___ ___ ___ ___
Ophthalmologic
Evaluation
___ ___ ___ ___ ___ ___ ___ ___
Thyroid
(TSH & T4)
___ ___ ___ ___ ___ ___ ___ ___
Nutrition ___ ___ ___ ___ ___ ___ ___ ___
Dental Exam1 ___ ___ ___ ___ ___ ___ ___ ___
Parent Support ___ ___ ___ ___ ___ ___ ___ ___
Developmental
& Educational
Services
___ ___ ___ ___ ___ ___ ___ ___
Neck X-rays & Neurological Exam2 ___ ___ ___ ___ ___ ___ ___ ___
Pelvic exam3   ___ ___ ___ ___ ___
Assess Contraceptive
Need3
  ___ ___ ___ ___ ___


Instructions: Perform indicated exam/screening and record date in blank spaces. The shaded boxes mean no action is to be taken for those ages.

1Begin Dental Exams at 2 years of age, and continue every 6 month thereafter.
2Cervical spine x-rays: flexion, neutral and extension, between 3-5 years of age. Repeat as needed for Special Olympics participation. Neurological examination at each visit.
3If sexually active.
© Down Syndrome Quarterly, 1999. This record sheet may be printed out for individual use but may not be reproduced on any website without prior permission.
 
Go to Birth to Age 12 Years Record Sheet

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