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Making Autism Cases Count
Complete this sheet every 6 months for your patients with Autism Spectrum disorders.
Personal Information
Your name *
Your answer
Your email *
Your answer
Consultation date *
MM
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DD
/
YYYY
Date of first consultation *
MM
/
DD
/
YYYY
Consultation number (1,2,3 etc) *
Your answer
Patient's initials *
Your answer
Patient's age *
Your answer
All patient's diagnoses
Your answer
Treatment
Category of treatment given (please check all that apply).
Please describe the treatment given.
Names of homeopathic remedies, supplements, isopathic prescriptions. Details of dosage (potency, frequency).
Your answer
Dietary advice.
Your answer
ATEC score (http://www.autism.com/ind_atec)
Date of ATEC score
MM
/
DD
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YYYY
ATEC total score
Your answer
ATEC subtest scores: Speech/Language Communication
Your answer
ATEC subtest scores: Sociability
Your answer
ATEC subtest scores: Sensory/Cognitive Awareness
Your answer
ATEC subtest scores: Health/Physical/ Behaviour
Your answer
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