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Alaska Blind Child Discovery

A cooperative, charitable research project to vision screen every preschool Alaskan

ABCD Paperwork

Clinic Report Sheet
Data sheet (front)
Warning Signs (back)
ABCD History

Please download these recent Adobe Acrobat (pdf) files and print, or copy them for your clinic. Each child should have a Data Sheet copies in such a manner that the "Warning signs" are on the reverse. Parents / Guardians should read, and sign the consent that is highlighted in the middle of the Data Sheet. Their return address goes in the rounded box and will show in a window-envelope that the ABCD Coordinating Center uses to mail their interpreted results. Parents should indicate if the child has had previous eye exams in, if so, results and identify the doctor. parents should identify significiant health problems and family history of eye disease. They should also read the reverse side and place a check next to any "Warning Signs" of pediatric Eye Disease. After you screen, write or afix (tape or staple) photos in the lower right corner. The screener should collect sorted groups of ten Data sheets on the clinic Report Sheet that ABCD will mail or fax to you. you can follow-up with parents of referred kids.

Kids Eye Disorders
Vision Screening
ABCD Clinics
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PlusOptix Screening Paperwork


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