Page 87 - DISINVESTMENT AND IMPLEMENTATION OF VISION SCREENING TESTS BASED ON THEIR EFFECTIVENESS
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Semistructured observation of population-based eye screening in The Netherlands
Appendix 2: Observation form
How many years have you been employed as an YHC physician?
Age of the child:
☐ 4 weeks ☐ 2 months ☐ 3 months ☐ 6 months ☐ 9 months☐ 12 months ☐ 14 months ☐ 1.5 years ☐ 2 years ☐ 3 years ☐ 4 years ☐ 4.5 years
Language level parents:
☐1☐2☐3 ☐4☐5
1. No Dutch 2. Poor Dutch 3. Moderate Dutch 4. Good Dutch 5.Native Dutch
Other important diagnoses of the child
Health development of the child:
☐ Personality, social behaviour ☐ Language development ☐ Fine motor skills ☐ Self and society
☐ Physical condition, overall health
Visual functions history of the child and his family
Performance of the VOV Hirschberg test:
☐ Gross motor skills
☐ Performed
Cover test:
☐ Performed
☐ With pen light
☐ Child on the lap of parents ☐ Child not on the lap of parents
☐ Complete covering of the eye ☐ Incomplete covering of the eye
☐ Too quick switching ☐ Switching adequately ☐ Not possible to perform
☐ Not performed ☐ Pen light
☐ Fixation object
☐ Not performed
☐ With ophthalmoscope ☐ With fixation object
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