Child and Teen Checkups
Translated Documents

The following Child and Teen Checkups (C&TC) materials are translated into other languages. If you are unable to find the information you need or have questions, please email health.childteencheckups@state.mn.us.

On this page:
Adolescent and Young Adult (AYA) Health Questionnaire
Child and Family Hearing History and JCIH Risk Assessment Questionnaire
Child and Family Vision History and Risk Assessment Questionnaire
Color Vision Advisory Letter
Fluoride Varnish Treatments and Your Child
Hearing Referral Letter
HIV and HIV Screening FAQ
Parent Confidentiality Letter
Vision Referral Letter
 

• Adolescent and Young Adult (AYA) Health Questionnaire - English (PDF)

  Other Languages: Translated AYA Health Questionnaire

  • Arabic العربية (PDF)
  • Hmong (Lus Hmoob) - Cov Lus Nug rau Cov Tub Ntxhais Hluas thiab Cov Neeg Laus es Tseem Hluas txog Kev Noj Qab Haus Huv (11-20 Xyoo) (PDF)
  • Karen (S’gaw Karen) - ပှၤလိၣ်ဘိဒီးပှၤသးစၢ်ဒိၣ်တုာ်ခိၣ်ပှဲၤ ဆူၣ်ချ့ဂ့ၢ်ဝီ တၢ်သံကွၢ်ရဲၣ်တဖၣ် (11-20 နံၣ်) (PDF)
  • Oromo (Afan Oromoo) - Gaafii Qorannoo Fayyaa  Dardaraa fi Dargaggootaa ( Waggaa 11-20) (PDF)
  • Russian (Русский) - Анкета о состоянии здоровья подростков и молодых людей (11–20 лет) (PDF)
  • Somali (Af Soomaali) - Su’aalaha Caafimaadka ee Qaangaarka iyo Dhallinta (11-20 Sano) (PDF)
  • Spanish (Español) - Cuestionario de Salud de Adolescentes y Adultos Jóvenes (11-20 Años) (PDF)
  • Vietnamese (Tiếng Việt) - Bảng Câu Hỏi Về Sức Khỏe Vị Thành Niên và Thanh Thiếu Niên (11-20 tuổi (PDF)

• Child and Family Hearing History and JCIH Risk Assessment Questionnaire - English (PDF)

  Other Languages: Translated Child and Family Hearing History and JCIH Risk Assessment Questionnaire

  • Arabic (JCIH* المخاطر ماستبیان حول التاریخ المرضي للسمع في الأسرة والطفل وتقییم) (PDF)
  • Hmong (Lus Hmoob) - Cov lus nug soj ntsuam txog Keeb Kwm thiab Kev Phom Sij ntawm tus menyuam thiab Tsev Neeg qhov hnov lus thiab JCIH (PDF)
  • Karen (S’gaw Karen) - ဖိသၣ်ဒီးဟံၣ်ဖိဃီဖိ အပူၤကွံာ်တၢ်နၢ်ဟူတၢ်အိၣ်သး ဒီး JCIH တၢ်သမံသမိးဆၢတဲာ် တၢ်လီၤဘၣ်ယိၣ်ဘၣ်ဘီ တၢ်သံကွၢ်ရဲၣ် (PDF)
  • Oromo (Afan Oromoo) - Seenaa  Dhageettii Daa’imaa  fi Maatii Gaaffii Saaxilamuu JCIH (PDF)
  • Russian (Русский) - Анкета по истории слуха ребёнка и семьи и управлению рисками JCIH (PDF)
  • Somali (Af Soomaali) - Taariikhda Maqalka Ilmaha iyo Qoyska iyo Su’aalaha JCIH ee Qiimeynta Khatarraha (PDF)
  • Spanish (Español) - Historial auditivo del niño y la familia y Cuestionario de evaluación de riesgos de JCIH (PDF)
  • Vietnamese (Tiếng Việt) - Tiền Sử Thính Lực của Trẻ và Gia Đình và Bảng Câu Hỏi Đánh Giá Nguy Cơ của JCIH (PDF)

• Child and Family Vision History and Risk Assessment Questionnaire - English (PDF)

  Other Languages: Child and Family Vision History and Risk Assessment Questionnaire

  • Arabic العربية (PDF)
  • Hmong (Lus Hmoob) - Cov lus nug soj ntsuam txog Keeb Kwm thiab Kev Phom Sij ntawm tus menyuam thiab Tsev Neeg Lub Qhov muag pom kev (PDF)
  • Karen (S’gaw Karen) - ဖိသၣ်ဒီးဟံၣ်ဖိဃီဖိ မဲာ်ချံတၢ်ထံၣ်ဂ့ၢ်ဝီ အပူၤကွံာ်တၢ်အိၣ်သး ဒီး တၢ်သမံသမိးဆၢတဲာ် တၢ်လီၤဘၣ်ယိၣ်ဘၣ်ဘီ တၢ်သံကွၢ်ရဲၣ် (PDF)
  • Oromo (Afan Oromoo) - Gaaffii Seenaa Qaroo Daa’immanii fi Maatii fi Madaallii Saaxilamuu (PDF)
  • Russian (Русский) - Анкета по истории зрения ребенка и семьи и управлению рисками (PDF)
  • Somali (Af Soomaali) - Su’aalaha Taariikhda Aragtida Ilmaha iyo Qoyska iyo Qiimeynta Khatarraha (PDF)
  • Spanish (Español) - Cuestionario de evaluación de riesgo e historial de la vista del niño y la familia (PDF)
  • Vietnamese (Tiếng Việt) - Tiền Sử Thị Lực của Trẻ và Gia Đình và Bảng Câu Hỏi Đánh Giá Nguy Cơ (PDF)

• Color Vision Advisory Letter - English (PDF)

  Other Languages: Color Vision Advisory Letter

  • Arabic خطاب استشاري حول إبصار الألوا ن (PDF)
  • Hmong (Lus Hmoob) - - Daim Ntawv Qhia Txog Kev Kuaj Qhov Muag Seb Puas Pom Cov Xim (PDF)
  • Karen (S’gaw Karen)- တၢ်ထံၣ်တၢ်အလွဲၢ် တၢ်ဟ့ၣ်ကူၣ်ဟ့ၣ်ဖး လံာ်ပရၢ (PDF)
  • Oromo (Afan Oromoo)- Xalayaa gorsa Qaroo haalluu (PDF)
  • Russian (Русский)- Рекомендательное письмо по цветовому зрению (PDF)
  • Somali (Af Soomaali)- Warqadda La-Talinta Aragga Midabka (PDF)
  • Spanish (Español)- Carta de aviso sobre la visión del color (PDF)
  • Vietnamese (Tiếng Việt)- Thư Tư Vấn Về Sắc Giác (PDF)

• Fluoride Varnish Treatments and Your Child - English (PDF)

  Other Languages: Fluoride Varnish Treatments and Your Child

  • Arabic علاجات ورنیش الفلوراید وطفل ك (PDF)
  • Hmong (Lus Hmoob) - Tshuaj Pleev Hniav (Fluoride Varnish) thiab Koj tus Menyuam (PDF)
  • Karen (S’gaw Karen) - ဖလိၣ်ရဲး ကသံၣ်ဖှူကတြ့ၣ်မဲ တၢ်ကူစါယါဘျါတဖၣ် ဒီး နဖိ (PDF)
  • Oromo (Afan Oromoo) - Wal’ansa Dibata Filooraayidii fi Daa’ima keessan (PDF)
  • Russian (Русский) - Фторирование зубов для ваших детей (PDF)
  • Somali (Af Soomaali) - Daaweynta Fluoride Varnish iyo Ilmahaaga (PDF)
  • Spanish (Español) - Los tratamientos con barniz de flúor y su hijo (PDF)
  • Vietnamese (Tiếng Việt) - Điều Trị Bằng Vecni Florua cho Con Quý Vị (PDF)

• Hearing Referral Letter - English (PDF)

  Other Languages: Hearing Referral Letter

  • Arabic خطاب إحالة السم ع (PDF)
  • Hmong (Lus Hmoob) - Daim Ntawv Xa Tawm Mus Kuaj Kev Hnov Lus (PDF)
  • Karen (S’gaw Karen) - တၢ်နၢ်ဟူ တၢ်ဆှၢခီဆူညါ လံာ်ပရၢ (PDF)
  • Oromo (Afan Oromoo) - Xalayaa rifarii dhaga’uur (PDF)
  • Russian (Русский) - Письмо о направлении к аудиологу (PDF)
  • Somali (Af Soomaali) - Warqadda Gudbinta ee Maqalka (PDF)
  • Spanish (Español) - Carta de remisión auditiva (PDF)
  • Vietnamese (Tiếng Việt) - Giấy Chuyển Tuyến Khám Thính Lực (PDF)

• HIV and HIV Screening FAQ - English (Word)

  Other Languages: HIV and HIV Screening FAQ

  • Arabic (HIV) فحص فیروس نقص المناعة البشریة (Word)
  • Hmong (Lus Hmoob) - Kab Mob HIV thiab Kuaj Kab Mob HIV (Word)
  • Karen (S’gaw Karen) - HIV ဒီး တၢ်မၤကွၢ် HIV တၢ်ဆါ (Word)
  • Oromo (Afan Oromoo) - HIV fi Qorannoo HIV (Word)
  • Russian (Русский) - ВИЧ и скрининг на ВИЧ (Word)
  • Somali (Af Soomaali) - HIV iyo Baaritaankiisa (Word)
  • Spanish (Español) - El VIH y la detección del VIH (Word)
  • Vietnamese (Tiếng Việt) - HIV và Sàng Lọc HIV (Word)

• Parent Confidentiality Letter - English (Word)

  Other Languages: Parent Confidentiality Letter

  • Arabic العربية - (Word)
  • Hmong (Lus Hmoob) - (Word)
  • Karen (S’gaw Karen) - (Word)
  • Oromo (Afan Oromoo) - (Word)
  • Russian (Русский) - (Word)
  • Somali (Af Soomaali) - (Word)
  • Spanish (Español) - (Word)
  • Vietnamese (Tiếng Việt) - (Word)

• Vision Referral Letter - English (PDF)

  Other Languages: Vision Referral Letter

  • Arabic العربية - (PDF)
  • Hmong (Lus Hmoob) - Daim Ntawv Xa Tawm Mus Kuaj Qhov Muag (PDF)
  • Karen (S’gaw Karen) - တၢ်ထံၣ် တၢ်ဆှၢခီဆူညါ လံာ်ပရၢ (PDF)
  • Oromo (Afan Oromoo) - Xalayaa referaalaa Qaroo (PDF)
  • Russian (Русский) - Письмо о направлении к офтальмологу (PDF)
  • Somali (Af Soomaali) - Warqadda Gudbinta Aragga (PDF)
  • Spanish (Español) - Carta de remisión de la visión (PDF)
  • Vietnamese (Tiếng Việt) - Giấy Chuyển Tuyến Khám Thị Lực (PDF)