Anamnese
Tanda Vital
TD : / mmHg Nadi : x/menit
RR : x/menit Suhu : ˚C
Perilaku Adaptif
Kontak Mata : _____________________________________________________________________
Atensi : _____________________________________________________________________
Perilaku : _____________________________________________________________________
Kemampuan Bahasa
Bicara Spontan : _______________________________________________________________
Pemahaman Bahasa : _______________________________________________________________
Pengujaran : _______________________________________________________________
Membaca : _______________________________________________________________
Penamaan : _______________________________________________________________
Wicara
Organ Wicara: Anatomis Organ Fisiologis
Lip Mandibula Lip Mandibula
Tongue Maxilla Tongue Maxilla
Hard Palate Dental Hard Palate Dental
Soft Palate Faring Soft Palate Faring
Uvula Uvula
Aktifitas Oral
Menghisap Mengunyah Meniup
Kemampuan Artikulasi
Subtitusi Omisi Distorsi Adisi
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