Children’s Long-Term Support Functional Screen Diagnoses Cue Sheet This alphabetical list of diagnoses indicates which box screeners should check on the Diagnoses table of the Children’s Long-Term Support Functional Screen (CLTS FS). For every diagnosis, the screener should: 1. See if it is listed in the CLTS FS Diagnoses Table and check relevant box on the table. Use the Search icon to help find the condition you are seeking. 2. If not on the CLTS FS Diagnoses Table, look for it in this Diagnoses Cue Sheet. If present here, check the box (es) on CLTS FS Diagnosis Table as indicated here. Also list the name of the specific condition/syndrome/diagnosis in the note section on the Diagnosis page. 3. If the diagnosis is not listed in this Cue Sheet, then check Diagnoses Table “Other,” and write it in. 4. Do not write in a diagnosis in “Other” until after making sure it is not on this Cue Sheet. 5. Do not guess which diagnoses on the CLTS FS diagnosis table to check. (See instructions.) Screeners should ignore letters or numbers before or after diagnoses. You can also ignore the following adjectives appearing before or after diagnoses: Words to Ignore: Active History of (check the diagnosis IF it is still current; see instructions) Acute Idiopathic Adolescent Intermittent Bilateral, left, right, Mild, Moderate Childhood Neonatal Classic NOS (means “not otherwise specified”) Congenital Primary End Stage Secondary General, generalized Severe Genetic S/P status post (check the diagnosis IF it is still current; see instructions) Juvenile Status post (check the diagnosis IF it is still current; see instructions) Chronic Recurrent Hereditary Common Abbreviations: FX Fracture R/O Rule Out LLE left lower extremity (leg) RLE right lower extremity (leg) LLL left lower lobe of lung RLL right lower lobe of lung LUE left upper extremity (arm) RUE right upper extremity (arm) LE Lower extremities (legs) RUL right upper lobe of lung NOS not otherwise specified For “Educational diagnosis of [anything]”: Include in Note Section, do not check a diagnosis For “Possible diagnosis of [anything]”: Include in Note Section, do not check a diagnosis For “Suspected diagnosis of [anything]”: Include in Note Section, do not check a diagnosis For “Rule out diagnosis of [anything]”: Include in Note Section, do not check a diagnosis For “Allergic to [anything]”: Allergy P-00920 (08/2017) CLTS FS P00920 08 17.doc, Page 1 of 30 Chromosomal Disorders: • There are 23 pairs of chromosomes, 46 chromosomes in all • Mind your ps and qs; chromosome deletions are often labeled as either [p] or [q]. • In medical reports it may be noted as a deletion or minus or [-]; these are all the same. • If the medical report indicates the specific band, for example 11.21, this is not important for purposes of this table. • Unbalance and Unbalance Translocation are the same thing If You See This Diagnosis Check This on CLTS FS Diagnosis Table Genetic / Chromosomal Disorder AND 10q deletion Developmental Delay 11;22 Unbalance Translocation (Robertsonian Genetic / Chromosomal Disorder AND Translocation) Developmental Delay 12p deletion Genetic / Chromosomal Disorder 18q deletion Genetic / Chromosomal Disorder 19 Unbalanced Translocation Genetic / Chromosomal Disorder 1p deletion Genetic / Chromosomal Disorder Genetic / Chromosomal Disorder AND 1p36 Deletion Mosaic Musculoskeletal Disorder Genetic / Chromosomal Disorder AND 1p36 Deletion Syndrome Cognitive Disability 1st Degree Heart Block Cardiac Condition 22q deletion Genetic / Chromosomal Disorder 22q13 Deletion Syndrome (Phelan-McDermid Genetic / Chromosomal Disorder AND Syndrome) Developmental Delay 4-Hydroxybutyric Aciduria (SSADH-D) Metabolic Disorder Genetic / Chromosomal Disorder AND 4p Deletion Syndrome (Wolf-Hirschhorn) Cognitive Disability 4q deletion Genetic / Chromosomal Disorder Genetic / Chromosomal Disorder AND 5p deletion (Cri Du Chat Syndrome) Cognitive Disability 8p deletion Genetic / Chromosomal Disorder Genetic / Chromosomal Disorder AND 9p deletion (Alfi Syndrome) Cognitive Disability Abscess of Liver Liver Disease (Hepatic Failure, Cirrhosis) Absence Of Corpus Callosum Brain Disorder (other than seizures) or Brain Damage Achalasia Digestive System Disorder Achilles Tendon Contractures Contracture / Connective Tissue Disorder Achondroplasia Musculoskeletal Disorder Acid Peptic Disease Digestive System Disorder Acid Reflux Digestive System Disorder Acidosis Metabolic Disorder Acne Include in Note Section, no Diagnosis checked Immune Deficiency (Do not include in notes due to Acquired Immune Deficiency Syndrome (AIDS) confidentiality) Acrocallosal Syndrome Brain Disorder (other than seizures) or Brain Damage Actinic Keratosis Skin Disease Acute Disseminated Encephalomyelitis (ADEM) Brain Disorder (other than seizures) or Brain Damage Acute Lymphocytic Leukemia (ALL) Cancer Acute Myelocytic Leukemia (AML) Cancer Adaptive Behavior Delay Include in Note Section, no Diagnosis checked Addiction To [A Drug Other Than Nicotine or Substance-Related Disorder (must verify diagnosis) Caffeine] P-00920 (08/2017) CLTS FS P00920 08 17.doc, Page 2 of 30 If You See This Diagnosis Check This on CLTS FS Diagnosis Table Addison’s Disease Metabolic Disorder Adenocarcinoma Cancer Adjustment Disorder Adjustment Disorder (must verify diagnosis) Adrenal Hyperplasia Endocrine Disorder (not Diabetes) Adrenal Insufficiency Endocrine Disorder (not Diabetes) Adrenoleukodystrophy (ALD) Metabolic Disorder Agenesis of the Corpus Collosum (ACC) Brain Disorder (other than seizures) or Brain Damage Aggressive Behavior Disorder Include in Note Section, no Diagnosis checked Agoraphobia Anxiety Disorder (must verify diagnosis) Agranulocytosis Immune Deficiency Aicardi Syndrome Immune Deficiency Immune Deficiency (Do not include in notes due to AIDS (Acquired Immune Deficiency Syndrome) confidentiality) Akathesia (Legs Tighten Up) Neuromuscular Disorder Alagille Syndrome Genetic / Chromosomal Disorder Albinism Genetic / Chromosomal Disorder Alcohol Related Neurodevelopmental Disorder Fetal Alcohol Syndrome / Effect Alcoholism / Alcohol Abuse or Addiction Substance-Related Disorder (must verify diagnosis) Genetic / Chromosomal Disorder AND Alfi Syndrome (9p deletion) Cognitive Disability Allergic to [anything] Allergy Alopecia Include in Note Section, no Diagnosis checked Alpha-1 Antitrypsin Deficiency Metabolic Disorder Alternating Hemiplegia Paralysis, Other than Spinal Cord Injury Ambiguous Genitalia Congenital Abnormality Ambloyopia (Lazy Eye) Include in Note Section, no Diagnosis checked Amniotic Bands Syndrome Congenital Abnormality Amputation / Missing Limb or Part of Limb Limb Missing, Severe Limb Abnormality, Arthrogryposis Amyoplasia Musculoskeletal Disorder Amyotrophic Lateral Sclerosis (ALS) Multiple Sclerosis or ALS Anencephaly Brain Disorder (other than seizures) or Brain Damage Genetic / Chromosomal Disorder AND Angelman Syndrome Cognitive Disability Angina Cardiac Condition Anophthalmia Blind or Severely Visually Impaired Anotia Congenital Abnormality Anoxic Encephalopathy / Brain Syndrome Brain Disorder (other than seizures) or Brain Damage Antiphospholipid Syndrome Immune Deficiency AODA (Alcohol or Other Drug Abuse) Substance-Related Disorder (must verify diagnosis) Aortic Sclerosis Cardiac Condition Aortic Valve Disease / Disorder / Stenosis Cardiac Condition Aperts Syndrome Genetic / Chromosomal Disorder Aphasia (Expressive or Receptive) Neuromuscular Disorder Skin Disease (if severe) OR Include in Note Section, no Aplasia Cutis Congenita Diagnosis checked Aplastic Anemia Anemia (e.g., Sickle Cell, Fanconi’s) Apnea or Sleep Apnea Respiratory Condition (other than Asthma) Apraxia / Apraxia of Speech Neuromuscular Disorder Aqueductal Stenosis Brain Disorder (other than seizures) or Brain Damage Arachnoid Cyst Brain Disorder (other than seizures) or Brain Damage P-00920 (08/2017) CLTS FS P00920 08 17.doc, Page 3 of 30 If You See This Diagnosis Check This on CLTS FS Diagnosis Table Brain Disorder (other than siezures) or Brain Damage (if Arachnoid Cysts cysts are in the brain), OR Include in Note Section, no Diagnosis checked Argininosuccinate Lyase Deficiency Metabolic Disorder Arhinia Congenital Abnormality Arnold Chiari Malformation Brain Disorder (other than seizures) or Brain Damage Arrhythmia Cardiac Condition Arthogryposis (Multiplex) Limb Missing, Severe Limb Abnormality, Arthrogryposis Articulation Disorder Include in Note Section, no Diagnosis checked Aspiration Include in Note Section, no Diagnosis checked Aspiration Pneumonia Infection – Current or Recurrent Infection Asplenia Include in Note Section, no Diagnosis checked Astigmatism Include in Note Section, no Diagnosis checked Brain Disorder (other than seizures) or Brain Damage AND Astrocytoma Cancer Ataxia Neuromuscular Disorder Ataxic Gait Neuromuscular Disorder Atelectasis Respiratory Condition (other than Asthma) Athetoid Cerebral Palsy Cerebral Palsy Atlantoaxial Instability (AAI) Include in Note Section, no Diagnosis checked Atonic Bladder Genitourinary System Disorder Atonic Colon Digestive System Disorder Atonic Diplegia Neuromuscular Disorder Skin Disease (if severe) OR Atopic Dermatitis Include in Note Section, no Diagnosis checked Atrial Fib / Fibrillation (A-Fib) Cardiac Condition Atrial Septal Defect Cardiac Condition Atrioventricular Canal / Endocardial Cushion Defect Cardiac Condition Atr-X Syndrome Genetic / Chromosomal Disorder Post-Traumatic Stress or Acute Stress Disorder OR Attachment Disorder Reactive Attachment Disorder Auditory Comprehension Delays