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ASQ-3 Developmental Screening in Primary Care Clinics

ASQ-3 Developmental Screening in Primary Care Clinics - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Questionnaires, Related



ASQ-3
Developmental Screening in Primary Care Clinics
November 11, 2014
1. Revised roll out date: 11/11/2014
2. Tools: ASQ-3.
a. Due to licensing restrictions, each site must purchase their own ASQ-3 tool set. Clinics may request
copies of Cover Letter, and age-specific Tool, Score Sheets, and Intervention Activities from Copy Center
(UWMF) or Office Max (UWHC).
b. English and Spanish tool kits are available. For non-English & non-Spanish populations, may either
continue Developmental Surveillance questions or enlist Interpreter at encounter to assist.
c. ASQ-3 should be completed at 9, 18, 24, and 48 months (4 year). The addition of the 48 month (4year)
is new.
3. Pre-visit Workflow: Reception staff
a. Gestational Age At Birth column can be added to the DAR (see screen shot below). This information will
be needed when using the ASQ Calculator. This can also be added to the Multiple Provider Schedule.



b. Review the provider schedule 2 weeks ahead for all 9, 18, 24, and 48 month (4 year) Well Child
Visits. Use the ASQ Calculator to determine the correct ASQ-3 form to be mailed to the
parent/guardian. Note: ASQ 3 administration date = mailing date.




ASQ-3
Developmental Screening in Primary Care Clinics
November 11, 2014





c. Special Circumstances: Prematurity requires an age-adjusted questionnaire. The Gestational Age at
Birth column in the Multiple Provider Schedule should be used. Round down when calculating weeks
premature (eg, enter 32 in the Age Calculator for a baby born at 32 5/7 weeks).

4. Day of Visit Workflow: Clinical Staff
a. Clinical staff receives completed ASQ-3 from parent. Label (if not already done) and score.
b. If not brought to clinic, clinical staff may provide age appropriate form to the parent to complete in the
clinic or to mail back to clinic once completed. Use ASQ Calculator to determine appropriate age form
to provide. The Administration date is the date of the visit. A link to the ASQ Calculatory has been
added to Health Link under the Epic Button->Clinical Resources.
c. Completed Tools and Score sheets should be given to provider prior to entry into room for visit.

5. Documentation: Clinical Staff and Providers
a. Clinical Staff records score in Questionnaires Activity under “ASQ3 Information Summary”.
Note: answers can be selected by typing first letter of word and then Enter (p=pass, b=borderline,
c=concern).
b. Follow up section is only completed by the clinical staff if the patient passes each of the areas (n=none).
c. The provider populates the Follow Up section if the score is anything but ” pass”, or the clinic staff
populates as directed by the provider. ( o=other, p=provide activity and rescreen, r=refer) . Provider
should direct follow up as needed.



ASQ-3
Developmental Screening in Primary Care Clinics
November 11, 2014



d. In the Well Child SmartText (WCNURAG or WCMDFULL) under the Development header, select “ASQ
Developmental Screening Link” to pull ASQ results into Progress Note. Other visit types use smart
phrase: .asq3results.



e. On completion of visit, ASQ-3 Score Sheet should be sent to scanning. These scored sheets will be found
in the media tab.




ASQ-3
Developmental Screening in Primary Care Clinics
November 11, 2014
6. Workflow for Tools Mailed To Clinic After Visit:
a. Following a WC visit
i. Create addendum to WC visit to record results in Questionnaires Activity under “ASQ3
Information Summary”
ii. Document in progress notes using smart phrase .asq3results
iii. Give to provider for interpretation
iv. Complete a phone call or letter to parent to discuss results
b. If ASQ-3 given outside of a WC visit
i. Open a Telephone Encounter with Reason for Call: “Results” and adding ASQ-3 into the
comment section.
ii. Record results in Questionnaires Activity under “ASQ3 Information Summary”
iii. Document in progress notes using smart phrase .asq3results
iv. Give to provider for interpretation
v. Complete a phone call or letter to parent to discuss results