| Condition |
T |
B |
F |
VP |
| Skip lines while reading or copying |
X |
X |
|
|
| Skip words while reading or copying |
X |
X |
|
|
| Reverse letters, numbers or words |
|
|
|
X |
| Use a finger or marker to keep place while reading/writing |
X |
X |
|
|
| Poor reading comprehension, difficulty remembering what you’ve read |
X |
X |
X |
X |
| Close (within 7‐8″) to reading and/or writing material |
|
X |
X |
|
| Vision blurs at distance when looking up from near work |
|
X |
X |
|
| Crooked or poorly spaced writing |
|
|
|
X |
| Poor spelling skills |
|
|
|
X |
| Letters or lines “run together” or words appear to “jump” when reading |
X |
X |
|
|
| Does not know math facts automatically |
|
|
|
X |
| Difficulty following instructions (written or verbal) |
|
|
|
X |
| Unable to remember a series of tasks |
|
|
|
X |
| Excessive blinking |
X |
X |
X |
|
| Excessive eye rubbing |
X |
X |
X |
|
| Totals |
17 |
23 |
11 |
21 |
| Maximum Possible |
69 |
84 |
54 |
55 |
