8.1.1.8
Develop EHS/HS (ASQ3)
Complete within 45 days of entry into each program option (EHS/FCC/HS).
Enter within 3 days of completion.
Event Date: Enter date the screening was completed
Status: Enter the appropriate status code
Colors refer to the chart on summary page of the ASQ-3
Passed: Scores within the white area on the ASQ-3 results page- Enter Closed Date using the same date as the Event Date
Needs Re-Screening: Scores within the gray area on the ASQ-3 results page-Follow the instructions for Develop EHS/HS (ASQ3) Follow Up to add a scheduled follow up action 30 days after initial screening date
Failed 1st: Scores within the black area on the ASQ-3 results page- follow the Referral for Observation/Consultation
Child has IEP/IFSP: Use when child scores a Needs Re-Screening or Failed 1st and is already receiving services for that area. Child does not need to be rescreened if they are receiving services. Enter Closed Date using the same date as the Event Date
Description: Enter the type of screener (Ex: 2mos)
Results: Enter score of each area as shown (60/50/35/15/55) Each must have 5 scores listed
Agency Worker: Ensure the Family Worker’s name is displayed