特殊需要儿童情况反馈表     
FEED-BACK INFORMATION OF SPECIAL NEED CHILD
| 儿童姓名:(原中文名) Child's Chinese Name         | 性别: Sex | 生日: DOB | 
| 收养时健康状况: Health Status of Child When Joining Family:     | 
| 医疗康复与抚育计划施行情况: Rehabilitation and Nurture Process:         | 
| 目前生长发育情况: Recent Developmental Status:         | 
组织名称:                                   填表日期 :
 
Name of organization:                   Filling date: