Visit with Parent Documentation Form
Date Baby’s name Who was present Age of baby G ___P___ Family had seen HUG DVD? Y/N
*On a scale of 1-5 (1 “is not very well “ and 5 is “great”) how would you describe your ability to address this issue
Zones | Did you explain Zones to parents? | Which Zones did baby exhibit? | Did baby move suddenly between Zones? | What help did the baby need to get from one Zone to another?
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SOS | Did you explain SOSs to parents?
| What Body SOSs did you see? | What Behavioral SOSs did you see? | How did you respond to the SOS? | * |
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Crying | Did baby show any self calming? | Did you point out self calming to parent? | Did you demonstrate stepwise calming? | Did you explain normal change in crying patterns of babies?
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Feeding | Did baby need help getting to the Ready Zone to eat?
| Did baby show any SOSs during feeding?
| What actions did you take in response to SOSs? | Was there some confusion about trying to feed baby while in the Resting Zone? | * |
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Sleeping | Did you explain two types of sleep? | What signs of active sleep did you observe? | Did you help parents consider how to help child “sleep through” active sleep?
| Did you suggest putting baby down in active sleep? | * |
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Playing | Did you try swaddling or sucking to enhance Ready Zone for play?
| Did you get baby to orient to a ball, rattle or face? | Did you get baby to turn to parent’s voice? | Were you and/or parents surprised by baby’s abilities? | * |
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