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.