Visit Documentation Forms: 2 ½ Year Visit

Please correct the errors described below.

WELL CHILD: 2 ½ YEAR VISIT

HISTORY

MEDICAL HISTORY

NUTRITION

Physical Activity:

DEVELOPMENT

  • Urinates in a potty or toilet
  • Plays pretend with toys or dolls
  • Pokes food with fork
  • Uses pronouns correctly
  • Explains the reasons for things, such as needing a sweater when it’s cold
  • Names at least one color
  • Walks up steps, using one foot, then the other
  • Runs well without falling
  • Grasps crayon with thumb and fingers instead of fist
  • Catches a large ball
  • Copies a vertical line

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

  • Day and evening routines
  • Enjoyable family activities
  • Parental activities outside the family
  • Consistency in the child’s environment
  • Use of simple words and reading together
  • Play with other children
  • Giving choices
  • Limits on TV and media use
  • Readiness for early childhood programs and playgroups
  • Toilet training
  • Car safety seats
  • Outdoor safety
  • Water safety
  • Sun protection
  • Fire and burns

PLAN

Immunizations:

Administered today:

Universal Screening:

Follow-up:

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