Table 2.

List of QuICCC Items*

1. Takes medicine prescribed by doctor *
2. Has life-threatening allergic reactions *
3. Follows special diet *
4. Regular doctor/specialist visits *
5. Sees counselor/psychiatrist, etc *
6.  Gets physical/occupational therapy or other
therapy regularly
*
7. Nursing or medical procedures at home or school
8. Hospitalized for condition still has or gets *
9. Unable to get needed service(s) *
10. Has serious physical delay *
11. Has serious mental/emotional delay *
12. Prevented/restricted in activity
13. Needs to reduce amount time or effort *
14. Difficulty eating
15. Blind or difficulty seeing *
16. Deaf or difficulty hearing *
17. Special equipment to eat
18. Special equipment to see
19. Special equipment to hear/communicate
20. Special equipment to walk
21. Special equipment for other function
22. Special arrangements at school *
23. Special class/instruction
24. Receives Early Intervention/has Family Service Plan
25. Trouble understanding simple instructions *
26. Unable to walk without help or support
27. Others have trouble understanding *
28. Unable to play or socialize
29. has Individualized Educational Plan
30. Difficulty feeding self
31. Difficulty dressing
32. Difficulty washing
33. Difficulty toileting
34. Uses help/equipment to feed self
35. Uses help/equipment to dress
36. Uses help/equipment to wash
37. Uses help/equipment to toilet
38. No sports/physical activities
39. Has Individualized Written Rehabilitation Plan
  • * Items appear in QuICCC-R (16-item short form).