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For people with Down syndrome, family members, caregivers and professionals.

Information Forms to Share with Hospitals and Clinics

May 2020 | Adult Down Syndrome Center - Resources

Visiting a hospital or clinic can be a stressful or frightening experience for some individuals with Down syndrome. The stress and fear can be increased if the healthcare providers are unfamiliar with the individual and their health history and/or a family member or caregiver is unable to be present. 

Several forms have been developed by a variety of organizations to help in My_Health_Passportthese situations. The forms prompt individuals with Down syndrome and their families to share information about the individual's health history, medications, communication preferences, and other needs. They are encouraged to fill out these forms and bring them to hospital or clinic visits so that the healthcare providers know how to best support the individual receiving medical care. We have provided links to two examples below. stony_brook_covid_forms

  • My Health Passport: This document was developed by the University of South Florida and Florida Center for Inclusive Communities. 
  • COVID-19 Forms: This link takes you to Stony Brook University's website. In response to COVID-19, Drs. Ballan and Perri developed a COVID-19 Disability Form with different versions for each state in the United States. The versions account for differences in states' Developmental Disabilities Services agencies and advance directive processes. 

Please note: The information on this site is for educational purposes only and is not intended to serve as a substitute for a medical, psychiatric, mental health, or behavioral evaluation, diagnosis, or treatment plan by a qualified professional. We recommend you review the educational material with your health providers regarding the specifics of your health care needs.