Visit Documentation Forms: 7 Year Visit

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Well Child | 7 Year Visits

HISTORY

Physical Activity

h/d:

School

DEVELOPMENT

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:

Sexual Maturity Rating

ASSESSMENT

ANTICIPATORY GUIDANCE

SOCIAL DETERMINANTS OF HEALTH

  • Neighborhood and family violence
  • Food security
  • Family substance use
  • Harm from the Internet
  • Emotional security and self-esteem
  • Connectedness with family and peers

DEVELOPMENT AND MENTAL HEALTH

  • Independence
  • Rules and consequences
  • Temper problems and conflict resolution
  • Puberty and pubertal development

SCHOOL

  • Adaptation to school
  • School problems (behavior or learning issues)
  • School performance and progress; school attendance
  • IEP or special education services
  • Involvement in school activities and after-school programs

PHYSICAL GROWTH AND DEVELOPMENT

  • Oral health
  • Nutrition
  • Physical activity

SAFETY

  • Car safety
  • Safety during physical activity
  • Water safety
  • Sun protection
  • Harm from adults
  • Gun safety

PLAN

Immunizations:

Universal Screening

Selective Screening (based on risk assessment) (See Previsit Questionnaire.):

Follow-up

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