Visit Documentation Form: 4 Month Visit

Please correct the errors described below.

Visit Documentation Form: 4 Months

HISTORY

Nutrition

Add new row

Problems with bottle-feeding

DEVELOPMENT

  • Laughs aloud
  • Rolls over prone to supine
  • Supports on elbows and wrists in prone
  • Keeps hands unfisted
  • Plays with fingers in midline.
  • Grasps object
  • Turns to voice
  • Vocalizes with extended cooing

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 )

  • Environmental risk: lead
  • Family relationships and support
  • Child care
  • General guidance on feeding
  • Feeding choices
  • Delaying solid foods
  • Breastfeeding or formula-feeding guidance
  • Supplements and over-the-counter medications
  • Infant self-calming
  • Parent-infant communication
  • Consistent daily routines
  • Media
  • Playtime
  • Maternal oral health
  • Teething and drooling
  • Good oral hygiene
  • Car safety seats
  • Safe sleep
  • Safe home environment

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...