CareTrack

📌 Recently Registered

📊 Disability Breakdown

🪪 Disability Card Status

Register New Child

Enter all available information for the child's disability record

👤 Personal Information

First Name *

Middle Name

Last Name *

Date of Birth *

Age (auto-calculated)

—

Sex

Hospital Number

Blood Type

📍 Address — Republic of Palau

State *

Hamlet / Village

Street / House / P.O. Box

👨‍👩‍👧 Parents / Guardian

Father's Full Name

Father's Mobile

Father's Home Phone

Father's Work Phone

Mother's Full Name

Mother's Mobile

Mother's Home Phone

Mother's Work Phone

Legal Guardian (if different from parents)

Guardian Relationship to Child

Guardian's Mobile

Guardian's Home Phone

Guardian's Work Phone

🩺 Disability Information

Primary Disability *

Severity Level

Mobility Level

Date of Diagnosis

Age at Diagnosis (auto-calculated)

—

Secondary / Additional Conditions

Diagnosis Notes

🏥 Clinical & Medical

Known Allergies (medications, food, environmental)

Immunization Status

Primary Physician / Specialist

Off-Island Referral History

📚 Services & Support

School / Institution

Grade / Level

IEP Status (Individualized Education Plan)

Current Services Received

🦽 Assistive Devices

Devices Currently Used (check all that apply)

Other / Additional Devices

💊 Medications

Current Medications (check all that apply)

Other / Additional Medications

Medication Notes (dosage, frequency, prescribing doctor…)

🤝 Social Assistance

Benefits / Subsidies Received (check all that apply)

Child Raising Subsidy Severely Disabled Fund Other (please specify)

Other Social Assistance — specify

🪪 Disability Card

Card Status

Card Number

Date Requested

Date Issued

Issuing Authority / Office

Card Expiry Date

Renewal Date

🚨 Emergency & Case Status

Emergency Contact Name

Emergency Contact Phone

Case Status

Assigned Case Worker

Additional Notes

Registered Children

Name	Age	Hospital No.	State / Hamlet	Disability	Parent / Guardian	Card	Status	Actions

User Management

Admin only — manage system access

Add New User

Full Name

Password

Role

CareTrack — Children with Disabilities Registry