Visit Documentation Forms: 2 Year Visit

Please correct the errors described below.

WELL CHILD: 2 YEAR VISIT

HISTORY

MEDICAL HISTORY

NUTRITION

Physical Activity:

DEVELOPMENT

  • Plays alongside other children
  • Takes off some clothing
  • Scoops well with spoon
  • Uses 50 words
  • Combines 2 words into phrase or sentence
  • Follows 2-step command
  • Uses words that are 50% intelligible to strangers
  • Kicks ball
  • Jumps off ground with 2 feet
  • Runs with coordination
  • Climbs up a ladder at a playground
  • Stacks objects
  • Turns book pages
  • Uses hands to turn objects (eg, knobs, toys, lids)

SOCIAL AND FAMILY HISTORY

REVIEW OF SYSTEMS

PHYSICAL EXAMINATION

Normal examination findings in text. Cross out abnormalities. Describe other findings in the area provided.

If "Genitourinary" is checked, please specify below:

ASSESSMENT

ANTICIPATORY GUIDANCE

  • Intimate partner violence
  • Living situation and food security
  • Tobacco, alcohol, and drug use
  • Parental well-being
  • Development
  • Temperament
  • Promotion of physical activity and safe play
  • Limits on media use
  • How child communicates and expectations for language
  • Promotion of reading
  • Techniques
  • Personal hygiene
  • Car safety seats
  • Outdoor safety
  • Gun safety

PLAN

Immunizations:

Administered today:

Universal Screening:

Follow-up:

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