Visit Documentation Forms: 3 Year Visit

Please correct the errors described below.

WELL CHILD: 3 YEAR VISIT

HISTORY

MEDICAL HISTORY

NUTRITION

Physical Activity

DEVELOPMENT

  • Goes to the bathroom and urinates by self
  • Plays and shares with others
  • Puts on coat, jacket, or shirt by self
  • Begins to play make-believe
  • Eats independently
  • Uses 3-word sentences
  • Uses words that are 75% intelligible to strangers
  • Understands simple prepositions(eg, on, under)
  • Tells a story from a book or TV
  • Compares things using words such as bigger or shorter
  • Pedals tricycle
  • Climbs on and off couch or chair
  • Jumps forward
  • Draws a single circle
  • Draws a person with head and one other body part
  • Cuts with child scissors

SOCIAL AND FAMILY HISTORY

Parent-child interaction:

Communication

Cooperation

Choices

Appropriate responses to behavior

REVIEW OF SYSTEMS

Required Field = Focus area for this Bright Futures Visit

PHYSICAL EXAMINATION

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

Genitourinary

ASSESSMENT

ANTICIPATORY GUIDANCE

  • Living situation and food security
  • Tobacco, alcohol, and drug use
  • Positive family interactions
  • Work-life balance
  • Play opportunities and interactive games
  • Sibling relationships
  • Reading, talking, and singing together
  • Language development
  • Water, milk, and juice
  • Nutritious foods
  • Competence in motor skills and limitson inactivity
  • Car safety seats
  • Choking prevention
  • Pedestrian safety and falls from windows
  • Water safety
  • Pets
  • Gun safety

PLAN

Universal Screening

Follow-up

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