wel child check templates

8/16/2019 Wel Child Check Templates

1/33

EWBORN WT/COLOR CHECK

SUBJECTIVE:

_-day old infant bon to a _ y!a old "_ at _ #!!$% by _& No '!(nan)y o d!li*!y 'obl!+%&

,ot! #a% blood ty'! _. HB%( n!(. 0b!lla i++0n!. "BS _. ot! lab% al%o 0n!+a$abl!& In

t! o%'ital. t! 'ati!nt !)!i*!d t! initial HBV *a))in!. 'a%%!d t! !ain( %)!!n. and ad

no+al '0l%! o1 %)!!nin(&

Sin)! (oin( o+!. t! 'ati!nt a% b!!n f!!din( #!ll. %toolin(/*oidin( no+ally. and b!a*in(

no+ally& T! +ot! a% no )on)!n%/20!%tion% today&

3EVELO4,ENT:

- "o%% +oto: Lift% !ad&

- 5in! +oto: ,o*in( all li+b% !20ally&

- Co(niti*!: Ey!% a''!a to fi1 on ob6!)t%/li(t%&

- So)ial/E+otional: ''!a% to !(ad fa)!% of ot!% 7at abo0t 89 in)!%&

- Co++0ni)ation: B!a*in( no+ally&

SOCIL H;:

No %+o$!% in t! o+!& Stabl!. tan20il fa+ily& No +a6o %o)ial %t!%%o% at o+!& ,ot! i%

doin( #!ll&

5,IL< H;:

No /o SI3S. ato'i) di%!a%!

OBJECTIVE:

- VITLS: _

- WEI"HTS: BW _& Today=% #!i(t _&

- "EN: No+al (!n!al a''!aan)!& N3&

- HE3: NCT& No )!'alo!+ato+a& 5OS5&

- EENT: R!d !fl!1 '!%!nt bilat!ally& No+al !1t !a%. no%!. li'%&

- ,OUTH: ,,,& No+al (0+%. +0)o%a. 'alat!. O4&

- NECK: S0''l!&

- CV: RRR. no +//(& No+al f!+oal '0l%!%&

- LUN"S: CTB. no #//)&

- B3: Soft. NT/N3. NBS. no +a%%!% o o(ano+!(aly& No+al 0+bili)al %t0+' #ito0t %0o0ndin(

!yt!+a& n0% > '!in!0+ no+al& No !nia%&

- "U: No+al _+al! (!nitalia& T!%t!% d!%)!nd!d bilat!ally&

- SKIN: WW4& No 6a0ndi)!. n!# %$in a%!%. o abno+al l!%ion%& No %a)al di+'l!&


2/33

- ,SK: No+al !1t!+iti!% > %'in!& No i' )li)$% o )l0n$%& No )la*i)0la fa)t0!&

- NEURO: ,E %y++!ti)ally& No+al +oo > %0)$ !fl!1!%& No+al +0%)l! ton!&

SSESS,ENT/4LN:

? H!alty n!#bon infant. doin( #!ll&

- Ro0tin! )a!& En)o0a(!d b!a%tf!!din(&

- 5/0 at 9 #!!$% of a(!. o %oon! 4RN&

? nti)i'atoy (0idan)! 7di%)0%%!d o )o*!!d in a ando0t (i*!n to t! fa+ily

- No+al n!#bon f!!din( and %l!!' 'att!n%

- Infant %o0ld al#ay% %l!!' on ba)$ to '!*!nt SI3S

- T0++y ti+!

- No %+o$in( in o+!: i%$ fo SI3S and a%t+a

- Saf!%t to %l!!' in )ib o ba%%in!t

- Ca %!at fa)in( ba)$#ad 0ntil 9 y!a% of a(! and 9@ 'o0nd%

- Wo$in( %+o$! ala+% and )abon dio1id! +onito% in o+!

- Hot #at! !at! to l!%% tan 89@ d!(!!%

- No+al )yin( *!%0% )oli). and #at to !1'!)t

- Wanin( %i(n% fo 'o%t'at0+ d!'!%%ion *!%0% baby bl0!%

- Si(n% of 6a0ndi)!

- Siblin( !n*y

- 4oly-Vi-Sol to %0''l!+!nt #it ion if +o%tly b!a%t f!!din(

- Ho# and #!n to )onta)t 0%

9 WEEKS

SUBJECTIVE:

9-#!!$ old infant bon to a _ y!a old "_ at _& No 'a!ntal )on)!n%/20!%tion% today&

ROS:

- Eatin( #!ll: _

- No )on)!n% abo0t %toolin( o *oidin(&

4,/SH:

No+al '!(nan)y and d!li*!y&

3EVELO4,ENT:

- "o%% +oto: Lift% !ad #!n on t0++y&

- 5in! +oto: ,o*in( all li+b% !20ally&

- Co(niti*!: Statin( to %+il!& Ey!% a! ta)$in( ob6!)t%/bi(t li(t%&


3/33

- So)ial/E+otional: A )on%olabl!& ''!a% to !(ad fa)!% of ot!% 7at abo0t 89 in)!%&

- Co++0ni)ation: Coo%&

SOCIL H;:

No %+o$!% in t! o+!& Stabl!. tan20il fa+ily& No +a6o %o)ial %t!%%o% at o+!& ,ot! i% doin( #!ll&

5,IL< H;:


OBJECTIVE:

- VITLS: _



- HE3: NCT& No )!'alo!+ato+a& 5OS5&

- EENT: R!d !fl!1 '!%!nt bilat!ally& No+al !1t !a%. no%!. li'%&

- ,OUTH: ,,,& No+al (0+%. +0)o%a. 'alat!. O4&

- NECK: S0''l!&

- CV: RRR. no +//(& No+al f!+oal '0l%!%&


- B3: Soft. NT/N3. NBS. no +a%%!% o o(ano+!(aly& No+al 0+bili)0%&


- SKIN: WW4& No 6a0ndi)!. n!# %$in a%!%. o abno+al l!%ion%& No %a)al di+'l!&

- ,SK: No+al !1t!+iti!% > %'in!& No i' )li)$% o )l0n$%& No )la*i)0la fa)t0!&

- NEURO: ,E %y++!ti)ally& No+al +oo > %0)$ !fl!1!%& No+al +0%)l! ton!&

NEWBORN SCREEN:

- R!%0lt% all n!(ati*!&

SSESS,ENT/4LN:

? H!alty 9-#!!$ old infant. doin( #!ll&

- 5/0 at - #!!$% of a(!. o %oon! 4RN&


- No+al n!#bon f!!din( and %l!!' 'att!n%

- Infant %o0ld al#ay% %l!!' on ba)$ to '!*!nt SI3S

- T0++y ti+!

- Ran(! of no+al bo#!l abit%





4/33


- No %+o$!% in t! o+!

- Hot #at! !at! to l!%% tan 89@ d!(!!%

- 5all '!*!ntion



- Siblin( !n*y

- No on!y. )on %y0'. )o#% +il$ 0ntil 8 y!a

- 5o+0la +i1in(

- 4oly-Vi-Sol %0''l!+!nt #it ion if +o%tly b!a%t f!!din( 7D 9 oF/day of fo+0la


- WEEKS

SUBJECTIVE:

_-#!!$ old infant !! fo a o0tin! #!ll )ild )!)$ and *a))in!%& No 'a!ntal )on)!n%/ 20!%tion% today&

ROS:

- Eatin( #!ll: _

- Stoolin(/*oidin( no+ally&

- B!a*in( no+ally&

- No )on)!n% abo0t %l!!' at ti% ti+!&

4,/SH:

No+al '!(nan)y and d!li*!y& No %0(!i!%. o%'italiFation%. o %!io0% illn!%%!% to dat!&

3EVELO4,ENT:

- "o%% +oto: bl! to old !ad %o+!#at %t!ady #!n '0ll!d to a %ittin( 'o%ition& bl! to '0% body 0'

#!n 'on!&

- 5in! +oto: ,o*in( all !1t!+iti!% %y++!ti)ally& Can old an ob6!)t bi!fly&

- Co(niti*!: Indi)at!% bo!do+ #!n +ini+al %ti+0lation& Ey!% ta)$ #!ll. and )an fi1 on ob6!)t%&

- So)ial/E+otional: S+il!%. loo$% at 'a!nt%. abl! to )o+fot %!lf&

- Co++0ni)ation: Coo%. *o)aliF!%& Ha% diff!!nt )i!% fo diff!!nt n!!d%&

SOCIL H;:

No %+o$!% in t! o+!& Stabl!. tan20il fa+ily& No +a6o %o)ial %t!%%o% at o+!& ,ot! i% doin( #!ll&

3ayti+! )a! i% _

5,IL< H;:



5/33

OBJECTIVE:

- VITLS: _



- HE3: NCT& 5OS5&

- E %'in!& No i' )li)$% o )l0n$%&

- NEURO: ,E %y++!ti)ally& No+al +0%)l! %t!n(t and ton!&

NEWBORN SCREEN:

- R!%0lt% all n!(ati*!&

SSESS,ENT/4LN:

? H!alty n!#bon infant. doin( #!ll&

- Ro0tin! )a!&

- 5/0 at G +ont% of a(!. o %oon! 4RN&

? Va))in!% today:

- 4!diai1 8 73Ta4. I4V. H!'B 9. 4CV 8. Rota 8. Hib 8

- 4!nta)!l 8 73Ta4. I4V. Hib. 4CV 8. Rota 8. H!'B 9

- Co+*a1 7Hib 8. H!'B 9. 4CV 8. Rota 8. 3Ta4 8. I4V 8


- Co++on i++0niFation SE%

- N0tition and f!!din( (o#t %'0t%

- No+al %l!!' 'att!n%& Infant %o0ld al#ay% %l!!' on ba)$ to '!*!nt SI3S

- T0++y ti+!




- Ca %!at fa)in( ba)$#ad 0ntil 9 y!a% of a(! 7id!ally 9 and 9@ 'o0nd%


6/33


- No %+o$!% in t! o+!

- Hot #at! !at! to l!%% tan 89@ d!(!!%

- 5all '!*!ntion



- Siblin( ad60%t+!nt


- 5o+0la +i1in(



G ,ONTHS

SUBJECTIVE:

G-+ont old infant !! fo a #!ll )ild )!)$& No 'a!ntal )on)!n%/20!%tion% today&

ROS:

- Eatin( #!ll: _

- Ha%nt ti!d %olid% y!t&

- No )on)!n% abo0t %toolin( o *oidin(&

- B!dti+! o0tin!: _

4,/SH:


3EVELO4,ENT:

- "o%% +oto: "ood !ad )ontol. in)l0din( #!n 'on!& "ood !ad )ontol #!n '0ll!d to a %ittin(

'o%ition&

- 5in! +oto: bl! to oll fo+ font to ba)$& R!a)!% fo ob6!)t%. and old% t!+ bi!fly&

- Co(niti*!: R!%'ond% to aff!)tion& Indi)at!% 'l!a%0! and di%'l!a%0!&

- So)ial/E+otional: La0(%. %20!al%& Can %!lf-)al+&

- Co++0ni)ation: Babbl!%. %+il!%&

SOCIL:

- No %+o$!% in t! o+!&

- No 'o%t'at0+ d!'!%%ion in +ot!&

- No +a6o %o)ial %t!%%o% at o+!&

- 3ayti+! )ild )a! i% #it _


7/33

- No TB i%$ fa)to%&

OBJECTIVE:

- VITLS: _


- HE3: NCT& 5OS5&

- E %'in!& No i' )li)$% o )l0n$%&


"ROWTH CHRT: 5ollo#in( (o#t )0*! #!ll in all 'aa+!t!%&

SSESS,ENT/4LN:

? H!alty G-+ont old infant

- 5ollo# 0' at +ont% of a(!. o %oon! 4RN&

- ER/!t0n '!)a0tion% di%)0%%!d&

? Va))in!% today:

- 4!diai1 9 73Ta4. I4V. H!'B . 4CV 9. Rota 9. Hib 9

- 4!nta)!l 9 73Ta4. I4V. Hib. 4CV 9. Rota 9. H!'B

- Co+*a1 7Hib 9. H!'B . 4CV 9. Rota 9. 3Ta4 9. I4V 9

? 4!+at0! 7D #!!$% o D & lb%

- Con%id! !+o(lobin



- Ho# and #!n to intod0)! %olid%

- No+al %l!!' 'att!n% 7d!)!a%!d ni(tti+! f!!d%. +o! !(0la %l!!' 'att!n%

- Infant %o0ld al#ay% %l!!' on ba)$ to '!*!nt SI3S 7fi%t +ont%. at l!a%t

- T!!tin( 7fi%t toot at -89 +ont%. a*!a(! +ont%

- T0++y ti+! '!*!ntion of 'la(io)!'aly



8/33






- Hot #at! !at! to l!%% tan 89@ d!(!!%

- 5all '!*!ntion





,ONTHS

SUBJECTIVE:

+ont old _ !! fo #!ll )ild )!)$& No 'a!ntal )on)!n% at ti% ti+!&

REVIEW O5 S


9/33

I,,UNIMTIONS:

- U' to dat!&

OBJECTIVE:

- VITLS: _


- HE3: NCT& 5OS5&

- E %'in!& No i' )li)$% o )l0n$%&


- "ROWTH CHRT: 5ollo#in( (o#t )0*! ni)!ly in all 'aa+!t!%&

SSESS,ENT/4LN:

? H!alty -+ont old infant

- T! fa+ily #a% (i*!n a )ild!n% boo$ today 7'! R!a) O0t and R!ad 'o(a+

- 5ollo# 0' at P +ont% of a(!. o %oon! 4RN&

- ER/!t0n '!)a0tion% di%)0%%!d&

? Va))in!% today:

- 4!diai1 73Ta4. I4V. H!'B G. 4CV . Rota . Hib . Infl0!nFa

- 4!nta)!l 73Ta4. I4V. Hib. 4CV . Rota . H!'B G. Infl0!nFa

- 4CV . Rota . 3Ta4 . I4V . Infl0!nFa 7Hib. H!'B to b! (i*!n at 89-+ont *i%it



- *oidin( 0%! of #al$!% and doo %#in(%/60+'!%&

- Cild 'oofin( t! o+!: "at!% fo %tai%. b0n '!*!ntion. $it)!n %af!ty. #at! %af!ty

- 4oi%on Contol n0+b! 7@@-999-8999


- T!!tin( and fl0oid! 7fi%t toot at -89 +ont%. a*!a(! +ont%


10/33

- Ho# and #!n to intod0)! %olid%: Ion-fotifi!d food%. d!layin( %#!!t food% and f0it%. no on!y/)on

%y0'/)o#% +il$ 0ntil on! y!a old. fin(! food%

- Co$in( aFad%

- No 60i)! fo+ bottl! no bottl! in b!d !aly 0%! of %i''y )0'

- S'!!) d!*!lo'+!nt 7i+'otan)! of !adin( and tal$in(

- Sl!!': S!'aation an1i!ty. ni(t a#a$!nin(. %l!!' tainin(. lo#! )ib +att!%%. %id! al!% 0'


P ,ONTHS

SUBJECTIVE:

P +ont old _ !! fo #!ll )ild )!)$& No 'a!ntal )on)!n% at ti% ti+!&

REVIEW O5 S


11/33

OBJECTIVE:

- VITLS: _


- HE3: NCT& nt!io fontan!ll! _

- E %'in!& No i' )li)$% o )l0n$%&


"ROWTH CHRT: 5ollo#in( (o#t )0*! ni)!ly in all 'aa+!t!%&

SSESS,ENT/4LN:

? H!alty P-+ont old infant

- T! fa+ily #a% (i*!n a )ild!n% boo$ today 7'! R!a) O0t and R!ad 'o(a+

- 5ollo# 0' at 89 +ont% of a(!. o %oon! 4RN&

- ER/!t0n '!)a0tion% di%)0%%!d&

? Va))in!% today:

- Infl0!nFa

- Non!


- *oidin( 0%! of #al$!% and doo %#in(%/60+'!%&

- Cild 'oofin( t! o+!: "at!% fo %tai%. b0n '!*!ntion. $it)!n %af!ty. #at! %af!ty

- 4oi%on Contol n0+b! 7@@-999-8999


- 3!ntal )a! and fl0oid! 7fi%t toot at -89 +ont%. a*!a(! +ont%

- 5ood: Ion-fotifi!d food%. no on!y/)on %y0'/)o#% +il$ 0ntil on! y!a old. fin(! food%. no/+ini+al

60i)!

- Co$in( aFad%

- No 60i)! fo+ bottl! no bottl! in b!d intod0)in( a %i''y )0'



12/33


13/33

- EN,T: T,%. na!%. and O4 no+al& ,,,& No+al (0+%. +0)o%a. 'alat!& "ood d!ntition&

- NECK: S0''l!. #it no +a%%!%&

- CV: RRR. no +//(&


- B3: Soft. NT/N3. NBS. no +a%%!% o o(ano+!(aly&


- SKIN: WW4& No %$in a%!% o abno+al l!%ion%&

- ,SK: No+al !1t!+iti!% > %'in!&



SSESS,ENT/4LN:

? H!alty _-+ont old toddl!

- T! fa+ily #a% (i*!n a )ild!n% boo$ today 7'! R!a) O0t and R!ad 'o(a+&

- T! fa+ily #a% (i*!n a li%t of d!nti%t% in t! )o0nty #o ta$! ,!diCal&

- CBC and l!ad l!*!l od!!d&


- ER/!t0n '!)a0tion% di%)0%%!d&

? Va))in!% today:

- 4oQ0ad 8 7,,R. Vai)!lla. H!' 8. 4CV G. Hib G. Infl0!nFa

- 4oQ0ad 8 7,,R. Vai)!lla. H!' 8. 4CV G. Infl0!nFa

- 4oQ0ad 8 7,,R. Vai)!lla. Co+*a1 7Hib . H!'B G. H!' 8. 4CV G. Infl0!nFa



- Saf!ty: Cild-'oof!d o+!. b0n '!*!ntion. $it)!n %af!ty. #at! %af!ty. fi!a+%. %0n%)!!n. 4oi%on

Contol n0+b! 7@@-999-8999


- 3!ntal )a! and fl0oid! d!ntal *i%it%

- 5ood: 5otifi!d #ol! +il$ 79 )0'%/day. li+itin( 60i)! and %#!!t%. fin(! food%. 'i)$y !atin(&

- Tan%itionin( fo+ bottl! to )0'% no bottl! in b!d

- Co$in( aFad%

- 3i%)i'lin!: 4ai%in( #ant!d b!a*io%. di%ta)tion. %!ttin( li+it%. o0tin!%&

- E+!(in( ind!'!nd!n)! 7off! )oi)!%


- Sl!!': Sl!!' y(i!n!. d!a+%


14/33

8 ,ONTHS

SUBJECTIVE:

_-+ont old _ !! fo #!ll )ild )!)$& No 'a!ntal )on)!n% at ti% ti+!&

REVIEW O5 S


15/33

- CV: RRR. no +//(&





- ,SK: No+al !1t!+iti!% > %'in!&

- NEURO: No+al +0%)l! %t!n(t and ton!& No fo)al d!fi)it%&


SSESS,ENT/4LN:






- ER/!t0n '!)a0tion% di%)0%%!d&

? Va))in!% today:

- 3Ta4 G. Infl0!nFa

- 4!nta)!l G 73Ta4. I4V. Hib. Infl0!nFa




Contol n0+b! 7@@-999-8999

- Ca %!at fa)in( ba)$#ad 0ntil 9 y!a of a(! and 9@ 'o0nd%


- 5ood: 4i)$y !atin(. fotifi!d #ol! +il$. li+itin( 60i)! and 60n$/fa%t food&


- 3i%)i'lin!: 4ai%in( #ant!d b!a*io%. di%ta)tion. %!ttin( li+it%. o0tin!%&



- Sl!!': Ni(t+a!%. %l!!' y(i!n!

- Li+itin( %)!!n ti+!

- HaFad% of %!)ond and %+o$!

8 ,ONTHS


16/33

SUBJECTIVE:

_-+ont old _ !! fo #!ll )ild )!)$& No 'a!ntal )on)!n% at ti% ti+!&

REVIEW O5 S


17/33

- CV: RRR. no +//(&





- ,SK: No+al !1t!+iti!% > %'in!&



SSESS,ENT/4LN:



- ,CHT don! today - No )on)!n%&


- 5ollo# 0' at 9 y!a% of a(!. o %oon! 4RN&

- ER/!t0n '!)a0tion% di%)0%%!d&

? Va))in!% today:

- H!' 9. Infl0!nFa




Contol n0+b! 7@@-999-8999

- Ca %!at fa)in( ba)$#ad 0ntil 9 y!a% of a(! 7id!ally 9 and 9@ 'o0nd%


- 5ood: 4i)$y !atin(. fotifi!d #ol! +il$. li+itin( 60i)! and 60n$/fa%t food&


- 3i%)i'lin!: 4ai%in( #ant!d b!a*io%. di%ta)tion. ti+! o0t%. %!ttin( li+it%. o0tin!%&


- "o#in( *o)ab0lay 7i+'otan)! of !adin( and tal$in(

- Li+itin( %)!!n ti+!

- Sl!!': Ni(t+a!%. %l!!' y(i!n!


9


18/33

9yo _ !! fo #!ll )ild )!)$& No 'a!ntal )on)!n% at ti% ti+!&

REVIEW O5 S


19/33





- ,SK: No+al !1t!+iti!% > %'in!&


"ROWTH CHRT: 5ollo#in( (o#t )0*! #!ll in all 'aa+!t!%& B,I at _ '!)!ntil!&

SSESS,ENT/4LN:

? H!alty 9yo toddl!



- ,CHT don! today - No )on)!n%&


- 5ollo# 0' at 9& y!a% of a(!. o %oon! 4RN&

- ER/!t0n '!)a0tion% di%)0%%!d&

? Va))in!% today:

- Infl0!nFa

- Non!


- Saf!ty: St!!t/)a %af!ty. #at! %af!ty. to1in%. (0n %af!ty&

- Boo%t! %!at !20i!d by la# 0ntil y% old o GP

- 5ood: 4i)$y !atin(. fotifi!d 9 +il$. li+itin( 60i)! and 60n$/fa%t food&

- 3!*!lo'+!nt: Toil!t tainin(. li+itin( %)!!n ti+!&

- 3i%)i'lin!: 4ai%in( #ant!d b!a*io%. tant0+ +ana(!+!nt. ti+! o0t%. %!ttin( li+it%. o0tin!%. off!in(

)oi)!%. dont !1'!)t %ain(&

- S'!!): No+al %'!!) dy%fl0!n)y. i+'otan)! of !adin( to )ild&


- Sl!!': Ni(t+a!%. %l!!' y(i!n!



20/33

- 3i!t: No )on)!n%&

- Voidin(/%toolin(: No )on)!n%& A toil!t tain!d 7d0in( t! day. at l!a%t&

- Sl!!'in(: No )on)!n%& Ha% !(0la b!dti+! o0tin!&

- 3!ntal: W!an!d fo+ t! bottl!& A b0%!% t!!t& Ha% b!!n to t! d!nti%t&

- B!a*io: No )on)!n%&

- )ti*ity: S)!!n/TV ti+! i% li+it!d to D 9 %/day. (!t% ti+! o0t%id! !*!y day&

4,/SH:


3EVELO4,ENT:

- "o%% and fin! +oto: Can %ta)$ - blo)$%. %tand on on! foot. '!dal a ti)y)l!. to# a ball o*!and.

#al$ 0' %tai% #it alt!natin( f!!t. )o'y a )i)l!. da# a '!%on #it t#o body 'at%. d!%% %!lf 7+ay n!!d

%o+! !l'&

- Co(niti*!: Kno#% na+!. a(!. %!1& Co0nt% to o +o!&

- So)ial/E+otional: Join% ot! )ild!n in 'lay& %$% 20!%tion%& bl! to na+! fi!nd%&

- Co++0ni)ation: Ot!% )an 0nd!%tand at l!a%t /G of #at i% %aid& S'!a$% in -G #od %!nt!n)!%&

,CHT in )at&

SOCIL:

- No %+o$!% in t! o+!&


- No %af!ty )on)!n% in t! o+!&

- 3ayti+! )ild )a! i% #it _

- No TB o l!ad i%$ fa)to%&

I,,UNIMTIONS:

- U' to dat!&

OBJECTIVE:

- VITLS: _


- HE3: NCT&

- E


21/33



- ,SK: No+al !1t!+iti!% > %'in!&



SSESS,ENT/4LN:

? H!alty yo )ild


- CBC od!!d&

- ,CHT #a% don! at 8 and 9G +ont% of a(!&

- 5ollo# 0' at G y!a% of a(!. o %oon! 4RN&

- ER/!t0n '!)a0tion% di%)0%%!d&

? Va))in!% today:

- Infl0!nFa

- Non!


- Saf!ty: St!!t/)a %af!ty. #at! %af!ty. to1in% 74oi%on Contol n0+b!: @@-999-8999. (0n %af!ty.

!l+!t% and %af!ty !20i'+!nt&


- 5ood: 4i)$y !atin(. fotifi!d %$i+ +il$. li+itin( 60i)! and 60n$/fa%t food&

- 3i%)i'lin!: 4ai%in( #ant!d b!a*io%. ti+! o0t%. %!ttin( li+it%. o0tin!%. off!in( )oi)!%. A!1'!)t

%ain(. li+itin( %)!!n ti+!&

- S'!!): I+'otan)! of !adin(. t!+'oay %t0tt!in(


- Sl!!': Ni(t+a!%. %l!!' y(i!n!


G


22/33


23/33



LBS/STU3IES:

- Uin! di' no+al&

- H!ain( %)!!n no+al&

SSESS,ENT/4LN:

? H!alty G yo )ild


- CBC od!!d& No indi)ation fo a li'id 'an!l o 3, %)!!nin(&

- ,CHT #a% don! at 8 and 9G +ont% of a(!&

- 5ollo# 0' at y!a% of a(!. o %oon! 4RN&

- ER/!t0n '!)a0tion% di%)0%%!d&

? Va))in!% today:

- Kini1 73Ta4 . I4V G. ,,R 9. Vai)!lla 9. Infl0!nFa


- Saf!ty: St!!t/)a %af!ty. %tan(!%. (0n %af!ty. !l+!t% and %af!ty !20i'+!nt&


- 5ood: Li+itin( 60i)! and 60n$/fa%t food&

- 3i%)i'lin!: 4ai%in( #ant!d b!a*io%. ti+! o0t%. %!ttin( li+it%. o0tin!%. off!in( )oi)!%&

- S'!!): I+'otan)! of !adin(. li+itin( %)!!n ti+!&




24/33

- )ti*ity: S)!!n/TV ti+! i% li+it!d to D 9 %/day. (!t% ti+! o0t%id! !*!y day&

4,/SH:


3EVELO4,ENT:

- "o%% and fin! +oto: Ho'% and %$i'%. old% )ayon o '!n)il #!ll. id!% a bi$!. abl! to ti! a $not )o'i!%

%20a!% and tian(l!%&

- Co(niti*!: 3a#% a '!%on #it !ad. body. and li+b% 7A body 'at% $no#% at l!a%t G )olo% )o0nt% to

o 8@ )an !1'lain t! 0%! of a ball o %o!&

- So)ial/E+otional: 4lay% )oo'!ati*!ly. 'lay% boad/)ad (a+!%. 'lay% +a$!-b!li!*!. li%t!n% and att!nd%&

- Co++0ni)ation: Can %'!a$ in f0ll %!nt!n)!% and t!ll a %toy. !)o(niF!% +o%t l!tt!%. 'int% %o+! l!tt!%

and n0+b!%&

SOCIL:

- In $ind!(at!n

- ft!-%)ool a)ti*iti!%:

- No %+o$!% in t! o+!&


- No %af!ty )on)!n% in t! o+!&


I,,UNIMTIONS:

- U' to dat!&

OBJECTIVE:

- VITLS: _


- HE3: NCT&

- E


25/33


LBS/STU3IES:

- Uin! di' no+al&


- Sn!ll!n t!%tin(: _

SSESS,ENT/4LN:

? H!alty yo )ild




- ER/!t0n '!)a0tion% di%)0%%!d&

? Va))in!% today:

- Infl0!nFa

- Non!


- Saf!ty: St!!t/)a %af!ty. %tan(!%. (0n %af!ty. !l+!t% and %af!ty !20i'+!nt&


- 5ood and !1!)i%!: Li+itin( 60i)! and 60n$/fa%t food. !1!)i%!&

- ,!+oiF! na+!. add!%%. and 'on! n0+b!&





26/33


3EVELO4,ENT:

- In _ (ad!& S)ool i% (oin( #!ll&

- Ha% fi!nd%&

- ft!-%)ool a)ti*iti!%: _

- 4y%i)al a)ti*ity 7and %af!ty: _

- S)!!n ti+!: _

- 3o!% )o!% #!n a%$!d&

- Kno#% add!%% and o+! 'on! n0+b!&

- Can na+! G- tin(% to !at in 9@ %!)ond%&

- 4int% l!tt!% #ito0t 'obl!+%&

- 3!%%!% %!lf #ito0t %0'!*i%ion&

SOCIL:

- Not!#oty %o)ial %t!%%o%: _

- No %+o$!% in t! o+!&


I,,UNIMTIONS:

- U' to dat!&

OBJECTIVE:

- VITLS: _


- HE3: NCT&

- E


27/33

- Uin! di' no+al&


- Sn!ll!n t!%tin(: _

SSESS,ENT/4LN:

? H!alty yo )ild



- ER/!t0n '!)a0tion% di%)0%%!d&

? Va))in!% today:

- Infl0!nFa

- Non!


- Saf!ty: St!!t %af!ty. %tan(!%. (0n %af!ty. !l+!t% and %af!ty !20i'+!nt&




- S)ool: Co++0ni)at! #it t!a)!%. di%)0%% '!! '!%%0! and b0llyin(. int!n!t %af!ty&





28/33


29/33

? H!alty yo )ild



- ER/!t0n '!)a0tion% di%)0%%!d&

? Va))in!% today:

- Infl0!nFa

- Non!


- Saf!ty: St!!t %af!ty. %tan(!%. (0n %af!ty. !l+!t% and %af!ty !20i'+!nt&




- S)ool: Co++0ni)at! #it t!a)!%. di%)0%% '!! '!%%0! and b0llyin(. int!n!t %af!ty&




-88


30/33

SOCIL:

- Not!#oty %o)ial %t!%%o%: _

- No %+o$!% in t! o+!&


I,,UNIMTIONS:

- U' to dat!&

OBJECTIVE:

- VITLS: _

- WEI"HT: B,I _


- HE3: NCT&

- E


31/33

- 4!! '!%%0!. b0llyin(. )o++0ni)ation #it t!a)!%. *iol!n)! '!*!ntion

- S!at b!lt%. !l+!t% and %af!ty (!a. %0n%)!!n

- Int!n!t %af!ty. li+itin( %)!!n ti+!

- ''o'iat! di%)i'lin! fo a(!

- H!alty food. !1!)i%!. (ood d!ntal y(i!n!

- Eli+inatin( (0n% fo+ t! o+!. o lo)$in( b0ll!t% %!'aat!ly


3OLESCENT 789 y% and old!

SUBJECTIVE:

_ !! fo #!ll )ild )!)$& No 'a!ntal o 'ati!nt )on)!n% at ti% ti+!&

RISK SSESS,ENT 7non-)onfid!ntial:

- Ha% n!*! faint!d b!fo!&

- No /o )o0(. )!%t 'ain. o %otn!%% of b!at #it !1!)i%!&

- Ha% n!*! ad a %i(nifi)ant !ad in60y&

- No fa+ily i%toy of %o+!on! dyin( %0dd!nly #il! !1!)i%in(&

- No fa+ily i%toy of ,I o %to$! b!fo! a(! &

RISK SSESS,ENT 7)onfid!ntial:

- Ho+!: Saf!. '!a)!f0l o+! !n*ion+!nt& 5a+ily +!+b!% all (!t alon(. +o! o l!%%&

- Ed0)ation/E+'loy+!nt: S)ool i% (oin( _& No 'obl!+% #it %af!ty o b0llyin( at %)ool&

- Eatin(: No )on)!n% abo0t body a''!aan)!& "!ttin( %0ffi)i!nt )al)i0+ in di!t 7at l!a%t G %!*in(% '!

day& No di!tay !%ti)tion%&

- )ti*iti!%: En6oy% an(in( o0t #it fi!nd%& S)!!n ti+! _& I% in*ol*!d in _

- 30(%: No i%toy of toba))o. EtOH. o d0( 0%!& No fi!nd% a! 0%in( t!%! %0b%tan)!%&

- Saf!ty: No i%toy of *iol!nt !lation%i'% at o+! o !l%!#!!&

- S!1: 4!f!% _& Ha% not b!!n %!10ally a)ti*! 7oal o (!nital y!t&

- S0i)idality/,!ntal H!alt: No )on)!n%& No i%toy of 'y%i)al o %!10al ab0%!& Sl!!'% #!ll at ni(t&

4,/SH:


OB/"


32/33

- 4lan% aft! i( %)ool: _

I,,UNIMTIONS:

- U' to dat!&

OBJECTIVE:

- VITLS: _

- WEI"HT: B,I _


- HE3: NCT&

- E


33/33

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