CDEs
Forms
Highest level of education
Do you consider yourself Hispanic/Latino?
If other, please specify
11. What is the primary language used in your home?
If other, please specify
12. Is a second language used in your home?
If yes, what is the second language?
If other, please specify
13. How many other children do you have?
14. Apart from having your baby screened through this program, is there anyone in your family who has/had Duchenne?
If other, please specify
Date of Dx
16. Have you had an opportunity to receive medical care from a pediatric center with expertise in Duchenne?
17. Has your baby's physician or other health care professional discussed the following management options with you?
18. Which of the following is part of your baby's current management?
19. Is your baby currently receiving support from any of the following specialties?
If other, please specify
20. Following your baby's diagnosis of Duchenne, did you receive additional genetic counseling?
21. Following your baby's diagnosis of Duchenne, did any one else in your family receive genetic counseling?
22. Has your baby's diagnosis of Duchenne caused you/your immediate family members to consider making changes to any of the following?
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