Module 2

Module 2.5 – 6 Month Check Up

Moico Module 3 Alt

An interim check in with caregivers to see if there are any changes in seizure activity, medications or therapies.

Please enter your child/ adult’s current age, height and weight (6moAgehw)
No Code Question Response
A.0.1 6MoAge Age in years and months
A.0.1 6MoHeight Height in cm:
A.0.1 6MoWeight Weight in kg:
In the past 6 months has there been any changes in your child/ adult’s (6motreatment)
NoCodeQuestionResponse
A.1.16MoEpilepsyEpilepsy1 – Yes – please report changes in “My Child/ Adult’s Treatment – Change in seizure activity”;
2 – No (6MoEpilepsyScale)
A.1.26MoSeizureHow have your child/ adult’s seizures changed (check all that apply)1 – Increased in frequency;
2 – Decreased in frequency;
3 – Change in seizure activity or symptoms;
4 – Other (please describe) (6MoSeizureScale)
A.1.36MoSeizureOthIf other, please describe. 
A.1.46MoMedMedications1 – Yes – please report changes in “My Child/ Adult’s Treatment – Started/ Changed or Stopped Medication”;
2 – No (6MoMedScale)
A.1.56MoMedChangeHow has your child/ adult’s medication changed in the last 6 months? Check all that apply1 – Started a new medication;
2 – Stopped a medication;
3 – Changed the dosage or frequency of a current medication;
4 – Other (please describe)
A.1.66MoMedChangeOthIf other, please describe. 
A.1.76MoTherapyTherapies1 – Yes – please report changes in “My Child/ Adult’s Treatment – Started/ Changed or Stopped Therapy”;
2 – No
A.1.86MoTherChangeHow has your child/ adult’s therapy service use changed in the last 6 months? Check all that apply1 – Started a new therapy;
2 – Stopped a therapy;
3 – Changed the duration or frequency of a current therapy;
4 – Other (please describe)
A.1.96MoTherChangeOthIf other, please describe. 

 

In the past 6 months, has your child/ adult (6motestclinic)
No Code Question Response
A.2.1 6MoPath Undergone any pathology or testing? 1 – Yes – please report in “My Child/ Adult’s Treatment – Pathology and Diagnostics”;
2 – No
A.2.1 6MoTrial Started or stopped taking part in any clinical trials or studies? 1 – Yes – please report in “My Child/ Adult’s Treatment – Clinical trials and studies”;
2 – No
A.2.1 6MoClinic Attended an Angelman clinic?

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Creating new opportunities, insight & understanding.
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