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"Aerodynamically, the bumblebee should not be able to fly.
But, the bumblebee does not know that so it goes on flying anyway."
~Mary Kay Ash

HYDRANENCEPHALY MEDICAL HISTORY
& FAMILY INFORMATION SURVEY

CHILD'S INFORMATION

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Seizures/EpilepsyHydranencephalyHydrocephalus with shuntHydrocephalus without shuntRefluxCerebral Palsy
Diabetes InsipidusAsthma/Reactive AirwayTracheostomyG-tube/J-tube/NG Tube

APPROVED POINTS-OF-CONTACT

PERSON ONE

PERSON TWO

PERSON THREE

UNIQUE FAMILY CIRCUMSTANCES

HEALTH HISTORY

TYPES OF SPECIALISTS SEEN

THERAPY SERVICES RECEIVED

ALTERNATIVE TREATMENT OPTIONS EXPLORED

PHARMACEUTICAL INTERVENTIONS

SPECIFIC NEEDS

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