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Diagnostic Plan Client Initials: Age: Gender: M / F Grad Student Clinician Goal: Grad Student Clinician Goal: INPUTS (Available Background Info.) Concern(s) (Referral Questions): PROCESS (Protocol you have planned in order to answer the referral questions and concerns) Brief Initial Phone Call: Do NOT email Meet with your supervisor first You cannot speak to anyone else (SLP) without permission from the family Confirm appointment day/time Request child’s game preferences If collecting audio/video sample from home, have them use UVM file transfer for big files (be aware of HIPAA) OUTCOME (Verify or rule out the following diagnostic hypotheses): H1 H2 H3 Other desired outcomes: Diagnostic Protocol: More information needed about: (If two students are assigned to a diagnostic evaluation, you cannot both get hours for the same activity. Both students must be actively engaged and performing distinct activities (e.g., parent interview and collecting a language sample or collecting data to check reliability of scoring).