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Institute of Nursing


Name of Student: ___________________________ Score: ______

Section/Grp: _____________ Date: _______

Grade description
3- correctly/completely done
2- incorrectly/incompletely done
1- not done
I. Before the Test
Activity 3 2 1 Remarks
1. The child can see and reach test materials easily
2. Explains the purpose of MMDST
3. Explains that the child is not expected to perform everything
asked of him
4. Calculates age of a child after asking parent the child’s
5. Before drawing age line, identifies if the child is born
6. Draws the age line correctly
7. Indicates the date test was administered at top of age line
II. During the Test
Activity 3 2 1 Remarks
Assures cooperation of child by:
8. Gives child a chance to become used to the examiner
9. Starts each sector of test with items the child could pass
10. Tells child what to do rather than asking
11. Clears table of materials which are not being used
12. Asks leading questions when asking parent’s report(e.g.
suggest answer)
13. Praises the child ONLY when he correctly performed an item
14. Asks the parent if the behavior of child typical of his usual
15. Gives enough items (at least 3 passes and 3 failures in each
III. After the test
Activity 3 2 1 Remarks
16. Shades right end of bar to emphasize delays
17. Indicates delays only on those items failed which were
completely to the left of age line
18. Interprets test performance correctly
19. Writes observations on back of form

***Based on thee MMDST Manual, Second Edition, 1999,UP Manila College of Nursing, pp.81-82

_______________________________ _________________________
Signature of Faculty Signature of Student