Visit Documentation Form: 6 Month Visit

Please correct the errors described below.

Visit Documentation Form: 4 Months

HISTORY

Nutrition

Add new row

Problems with bottle-feeding

DEVELOPMENT

  • Pats or smiles at reflection
  • Begins to turn when name called.
  • Babbles
  • Rolls over supine to prone
  • Sits briefly without support
  • Reaches for object and transfers
  • Rakes small object with 4 fingers
  • Bangs small object on surface

SOCIAL AND FAMILY HISTORY

REVIEW OF SYSTEMS

Required Field = Focus area for this Bright Futures Visit

PHYSICAL EXAMINATION

Required Field = Focus area for this Bright Futures Visit

Genitourinary:

ASSESSMENT

ANTICIPATORY GUIDANCE (Discussed and/or handout given )

  • Living situation and food security
  • Tobacco, alcohol, and drug use
  • Parental depression
  • Family relationships and support
  • Child care
  • General guidance on feeding
  • Solid foods
  • Pesticides in vegetables and fruits
  • Fluids and juice
  • Breast or formula-feeding guidance
  • Parents as teachers
  • Communication and early literacy
  • Emerging infant independence
  • Putting self to sleep
  • Self-calming
  • Fluoride
  • Oral hygiene/soft toothbrush
  • Avoidance of bottle in bed
  • Car safety seats
  • Safe sleep
  • Safe home environment: burns, sun exposure, choking, poisoning, drowning, and falls

PLAN

Universal Screening

Selective Screening (based on risk assessment) (See Previsit Questionnaire.):

Follow-up

DISCLAIMER: By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.

Your information will be encrypted.

Loading...