CDEs
Forms
Expressive Communication scaled score:
Expressive Communication developmental age equivalent:
Cognitive raw score:
Cognitive scaled score:
Cognitive developmental age equivalent:
Cognitive percentile: (%)
Motor percentile: (%)
Language percentile: (%)
Age at Dx
When did the parent or provider note medical concerns or symptoms?
Please check concerns or symptoms that were first noticed.
DMD Diagnosis
Patient Classification
If other, please specify
1. What was/were the most important reason(s) you decided to have your baby screened for Duchenne?
If other, please specify
Before the screening test, you should have been given a brochure, a consent form (the paper that you signed to allow your baby to be screened), and been offered an opportunity to watch a video. Also, someone should have talked with you about the screening test. Please answer the following questions about information that was given to you.
2. Were you given any written information about screening for Duchenne?
3. Did you feel you had enough time to review the information?
4. How well did you understand the information about Duchenne screening?
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