2. A patient at 40 weeks’ gestation arrives to OB

Life Domain Functioning 0 – Indicates a life domain in which there is no evidence of a need. 1 – Indicates a life domain in which there is a relevant history or suspicion of a need where watchful waiting* is recommended. 2 – Indicates a life domain in which the child/adolescent is having problems and/or action is required to improve functioning. 3 – Indicates a life domain in which the child/adolescent is having severe problems and/or immediate action is required to improve functioning. Item Number Item Score Item-Definition Glossary 1. Family Functioning 0 1 2 3 link to user guide 2. Social Functioning 0 1 2 3 link to user guide 3. Medical/Physical 0 1 2 3 link to user guide 4. Developmental Delay 0 1 2 3 link to user guide 5. Learning Disability 0 1 2 3 link to user guide 6. Sexual Behavior 0 1 2 3 link to user guide 7. Self Care 0 1 2 3 link to user guide 8. Community 0 1 2 3 link to user guide 9. School Behavior 0 1 2 3 link to user guide 10. School Achievement 0 1 2 3 link to user guide 11. School Attendance 0 1 2 3 link to user guide

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