Visit Documentation Forms: 12 Months Visit

Please correct the errors described below.

HISTORY

Physical Activity

DEVELOPMENT

  • Looks for hidden objects
  • Imitates new gestures
  • Says, “Dad” or “Mom” with meaning
  • Uses one word other than Mom or Dad, or personal names
  • Follows a verbal command that includes a gesture
  • Takes first independent steps
  • Stands without support
  • Drops object in a cup
  • Picks up small object with 2-finger pincer grasp
  • Picks up food and eats it

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

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

Genitourinary:

ASSESSMENT

ANTICIPATORY GUIDANCE (Discussed and/or handout given)

  • Living situation and food security
  • Tobacco, alcohol, and drug use
  • Social connections with family and others
  • Adjustment to development changes and behavior
  • Family time
  • Bedtime, nap time, and teeth brushing
  • Media
  • Car safety seats
  • Falls
  • Drowning prevention and water safety
  • Sun protection
  • Pets
  • Poisoning
  • First dental checkup and dental hygiene
  • Self-feeding
  • Continued breastfeeding; transition to family meals
  • Nutritious foods

PLAN

Universal Screening

Anemia (Result)

Result

Oral health

Formatted text

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