Daily Report 每日报告
Student Name 学生姓名:
*
Date 日期
*
-
Day
-
Month
Year
Time 时间
*
Hour Minutes
AM
PM
AM/PM Option
Until
until
Hour Minutes
AM
PM
AM/PM Option
Therapist Name 治疗师姓名
*
Skills Involved Today 今日技能包含:
*
Table Tasks
Fine Motor Skills
Gross Motor Skills
Life Skills
Social Emotional / Play Skills
Activity-based
Other
Overall Performance 整体表现
Overall performance 整体表现
*
Rows
Need improvement 欠佳
Average 还行
Good 良好
Exceptional 优异
Behavior 行为
Compliance 服从
Instruction 指令
Transition 空间/活动转换
Remark:
Table Tasks
Table Tasks
Task 1:
Description:
Prompt:
Heavy
Moderate
Minimal
None
Performance:
Need improvement
Average
Good
Exceptional
Remark:
Task 2:
Description:
Prompt:
Heavy
Moderate
Minimal
None
Performance:
Need improvement
Average
Good
Exceptional
Remark:
Task 3:
Description:
Prompt:
Heavy
Moderate
Minimal
None
Performance:
Need improvement
Average
Good
Exceptional
Remark:
Task 4:
Description:
Prompt:
Heavy
Moderate
Minimal
None
Performance:
Need improvement
Average
Good
Exceptional
Remark:
Task 5:
Description:
Prompt:
Heavy
Moderate
Minimal
None
Performance:
Need improvement
Average
Good
Exceptional
Remark:
Task 6:
Description:
Prompt:
Heavy
Moderate
Minimal
None
Performance:
Need improvement
Average
Good
Exceptional
Remark:
Fine Motor Skills
Fine Motor 1:
Description:
Prompt:
Heavy
Moderate
Minimal
None
Performance:
Need improvement
Average
Good
Exceptional
Remark:
Fine Motor 2:
Description:
Prompt:
Heavy
Moderate
Minimal
None
Performance:
Need improvement
Average
Good
Exceptional
Remark:
Gross Motor Skills
Gross Motor 1:
Description:
Prompt:
Heavy
Moderate
Minimal
None
Performance:
Need improvement
Average
Good
Exceptional
Remark:
Gross Motor 2:
Description:
Prompt:
Heavy
Moderate
Minimal
None
Performance:
Need improvement
Average
Good
Exceptional
Remark:
Life Skills
Life Skill 1:
Description:
Prompt:
Heavy
Moderate
Minimal
None
Performance:
Need improvement
Average
Good
Exceptional
Remark:
Toilet Training:
With diaper
With Training pants
Request to go
Other
Time:
Remark:
Social Emotional / Play Skills
Activity 1:
Description:
Prompt:
Heavy
Moderate
Minimal
None
Performance:
Need improvement
Average
Good
Exceptional
Remark:
Activity 2:
Description:
Prompt:
Heavy
Moderate
Minimal
None
Performance:
Need improvement
Average
Good
Exceptional
Remark:
Activity-Based
Activity-based 1:
Description:
Prompt:
Heavy
Moderate
Minimal
None
Performance:
Need improvement
Average
Good
Exceptional
Remark:
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