Feed-back Information of Special Needs Child -- china.org.cn

特殊需要儿童情况反馈表
FEED-BACK INFORMATION OF SPECIAL NEED CHILD

儿童姓名：(原中文名)

Child's Chinese Name

性别：

Sex

生日：

DOB

收养时健康状况：

Health Status of Child When Joining Family:

医疗康复与抚育计划施行情况：

Rehabilitation and Nurture Process:

目前生长发育情况:

Recent Developmental Status:

组织名称: 填表日期 :

Name of organization: Filling date:

(China-ccaa.org October 16, 2006)