Part Part 2 - Disability Care Load Assessment (Child) Determination 2009 - Professional questionnaire

Part 2 Professional questionnaire

Functional domains — abilities Functional domains — abilities

Functional domains — abilities

For the functional domains numbered 1 to 8, the treating health professional must mark only the statement that describes the best ability that the child has in each functional domain. The child’s abilities include what the child can do when using the child’s aids, appliances or other special equipment items.

	Question	Response Code
1	Receptive language skills (listening, reading and understanding)
	Child understands adult speech or signed language of normal speed and complexity. Child demonstrates full understanding of why they are interacting with a health professional	M-1j
	Child can read and interpret a paragraph from the front page of a daily newspaper	M-1i
	Child can read a paragraph or page from a children’s story book appropriate for the child’s age group. Child can recall a list of three common objects 30 seconds after the list is read to them	M-1h
	Child understands and responds appropriately to simple questions such as ‘do you go to school?’ and ‘what is your favourite colour?’	M-1g
	Child follows 2 step instructions such as ‘pick up the book and put it on the chair’. Child uses toys appropriately for their intended purpose in meaningful play	M-1f
	Child knows the difference between ‘big’ and ‘little’. Child can demonstrate what common objects are used for	M-1e
	Child recognises pictures of common objects, for example points appropriately when asked ‘where’s the dog?’ or ‘which one is the truck?’	M-1d
	Child responds appropriately to very simple questions, for example points to, or looks at, mother when asked ‘where’s mummy?’. Child uses objects purposefully, for example to make a sound	M-1c
	Child responds to sound. Child tracks noise-making objects	M-1b
	Child looks momentarily at speaker’s face	M-1a
	Child cannot do any of the things listed above

	Question	Response Code
9	Behaviour
	Child is consistently uncooperative and disruptive during treatment or assessment episodes	M-9a
	Child demonstrates self injurious behaviour such as head banging or hand biting and has injuries or signs of past injuries consistent with such behaviours	M-9b
	Child displays aggressive behaviour or violence towards other people or property in the treatment or assessment setting	M-9c
	Child persistently attempts to leave or abscond from the treatment or assessment setting	M-9d
	Child is extremely active and is unable to concentrate on a task for more than 30 seconds	M-9e
	Child displays obsessional repetitive behaviours, for example obsession with particular objects or twirling or spinning objects for extended periods of time	M-9f
10	Special care needs
	Child receives all food and fluids by nasogastric or gastrostomy tube or percutaneous enterogastric tube (PEG)	M-10a
	Child has a tracheostomy	M-10b
	Child is aged over 4 years and is incontinent both day and night	M-10c
	Child is aged over 3 years and cannot stand without support	M-10d
	Child requires a wheelchair and requires assistance to propel the wheelchair	M-10e
	Child requires a wheelchair, quad sticks, prosthesis, crutches or walking frame but can move around with little assistance using the equipment	M-10f
	Child uses an electric wheelchair	M-10g
	Child requires urinary catheterisation several times each day	M-10h
	Child requires specialised equipment, prosthesis or technology to communicate, for example a computerised communicator, telephone typewriter (TTY), voice synthesiser, cochlear implant, hearing aids or adaptations to a standard computer	M-10i
	Child is over the age of 5 years and has persistent difficulties with memory, concentration, planning and organisation	M-10j
	Child has chronic and progressive suppurative lung disease for which ongoing daily airway clearance is provided or enzyme replacement therapy and nutritional supplements are required and provided on a daily basis	M-10k
	Child has an inherited metabolic disorder that is being treated by medically prescribed diet as the basis of treatment so that it will not lead to neurological disability	M-10l
	Child is assisted with the administration of medication on a daily basis to control seizures and medication does not substantially reduce the frequency of seizures and the child may require immediate or emergency attention to prevent harm resulting from a seizure	M-10m
	Child is assisted on a daily basis with at least 2 blood tests to measure blood glucose levels, injections and special dietary management and the child is not capable of determining medication levels, food intake or self-administration of medication	M-10n

Part 2Professional questionnaire

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Functional domains — abilities Functional domains — abilities

Functional domains — abilities

Functional domains — behaviour and needs Functional domains — behaviour and needs

Functional domains — behaviour and needs