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  • Are there any concerns with the following musculoskeletal areas?
  • If other, please specify
  • Are there any concerns with cardiac function?
  • If yes, please explain
  • Is there a record of a baseline ECHO?
  • If yes, at what age (in months) was the baseline ECHO?
  • Scoliosis
  • If yes, is scoliosis:
  • Behavioral concerns
  • Immunization status
  • Current DMD symptoms:
  • Describe other symptoms
  • First presenting symptom(s):
  • First concern
  • If other, please specify
  • Symptom onset age value
  • Age at 1st symptom unit
  • Approximate age at 1st symptom
  • Developmental assessment done at this visit
  • Standardized developmental screening tool(s) used
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