Professional Documents
Culture Documents
56
Health care facility SECTOR 2 BUCHAREST
DOCTOR'S OFFICE
(name, address, phone).....................................................
Recommendations
Normal physical activity YES NO restrictions (if necessary):.............................
Diverse diet YES NO restrictions:.............................
Reassessment is necessary NO YESfor................scheduled date_ _/_ _/_ _
Development (preschoolers)
Within normal limits YES NO:..................................
If you checked no, state the type of impairment:
-cognitive...............................................
-communication/speech........................
-emotional/social....................................
-adaptation.............................................
-motricity................................................
Hearing
Audiometry (if necessary)
normal
abnormal
Sight
Visual acuity normal YESNO
Left eye:.................
Right eye:...............
Corrective lenses YESNO
Strabismus NOYES
Additional examinations NOYES which:.......
Requires special education
Others....................
Assessment results
Child apt/inaptfor enrolment in community
Observations...........
MEDICAL CERTIFICATE
(handwriting) 2007-09-14
Clinically healthy.
Apt for community
Dr. Cojocaru