Template
Well Child Check
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VisitChoose oneFirst line
GrowthChoose any
DevelopmentChoose any
Newborn screensChoose anyNot in the note with these choices
Maternal depression screenChoose oneNot in the note with these choices
Developmental screenChoose anyNot in the note with these choices
Autism screenChoose anyNot in the note with these choices
VisionChoose oneNot in the note with these choices
HearingChoose oneNot in the note with these choices
Adolescent hearingChoose anyNot in the note with these choices
Blood pressureChoose oneNot in the note with these choices
FluorideChoose anyNot in the note with these choices
HemoglobinChoose anyNot in the note with these choices
LeadChoose anyNot in the note with these choices
LipidsChoose oneNot in the note with these choices
AdolescentChoose anyNot in the note with these choices
Substance use screenChoose oneNot in the note with these choices
Sudden cardiac arrest riskChoose anyNot in the note with these choices
Depression screenChoose oneNot in the note with these choices
Sexual healthChoose anyNot in the note with these choices
HIVChoose anyNot in the note with these choices
ImmunizationsChoose oneNot in the note with these choices
Immunizations (none routinely due)Choose oneNot in the note with these choices
Influenza vaccineChoose anyNot in the note with these choices
RSVChoose anyNot in the note with these choices
ReferralChoose any
Family questions discussedChoose any
Follow-upChoose one
Follow-up reasonChoose anyJoins the line aboveNot in the note with these choices
CounselingNot in the note with these choices
Discussed feeding and signs of good intake, jaundice, cord and skin care, fever and when to call, handwashing and limiting outings, calming a crying baby, safe sleep on the back in a crib, car seat use, and avoiding smoke exposure.
CounselingNot in the note with these choices
Discussed feeding, sleep and waking, fussiness and calming, parental well-being and postpartum mood, safe sleep, car seat use, preventing falls, and when to call after hours.
CounselingNot in the note with these choices
Discussed feeding and holding off on solid foods, hunger and fullness cues, sleep, talking and playing together, tummy time, parental mood, safe sleep, car seat use, and preventing burns, falls, and drowning.
CounselingNot in the note with these choices
Discussed self-soothing and routines, talking and reading together, teething and oral care with no bottle in bed, feeding and readiness for solid foods around 6 months, safe sleep, car seat use, and home safety.
CounselingNot in the note with these choices
Discussed starting solid foods and introducing common allergens, cup drinking and avoiding juice, fluoride and brushing with a soft toothbrush, reading and talking together, putting self to sleep and safe sleep, car seat use, and preventing burns, choking, poisoning, drowning, and falls.
CounselingNot in the note with these choices
Discussed changing sleep patterns, mobility and learning, self-feeding and table foods, cup drinking and plans for weaning, consistent and positive discipline, car seat use, firearm safety, and preventing burns, poisoning, drowning, and falls.
CounselingNot in the note with these choices
Discussed routines for meals, naps, bedtime, and toothbrushing, whole milk and family foods, establishing a dental home, limiting screen time, car seat use, water and sun safety, and poison prevention.
CounselingNot in the note with these choices
Discussed language and social development, bedtime routines and night waking, temperament and discipline with distraction and consistent limits, toothbrushing, car seat use, and fire, fall, and poison safety.
CounselingNot in the note with these choices
Discussed signs of toilet training readiness, consistent limits, encouraging language through reading, talking, and singing, limiting media, healthy foods and drinks, car seat use, sun protection, firearm safety, and preventing burns and falls.
CounselingNot in the note with these choices
Discussed temperament and behavior, language development and reading together, toilet training, physical activity and limits on media, car seat use, outdoor safety, and firearm safety.
CounselingNot in the note with these choices
Discussed family routines, reading and language, play with other children, preschool readiness and toilet training, limits on media, car seat use, and water, sun, and fire safety.
CounselingNot in the note with these choices
Discussed play with siblings and peers, reading, talking, and singing together, healthy foods and drinks, physical activity, car seat use, choking prevention, pedestrian and window safety, water safety, and firearm safety.
CounselingNot in the note with these choices
Discussed school readiness, healthy foods and daily routines, limits on media and physical activity, car seat or booster seat use, outdoor and water safety, sun protection, and firearm safety.
CounselingNot in the note with these choices
Discussed family rules and routines, school and after-school activities, daily toothbrushing and dental visits, healthy foods, an hour of physical activity a day, booster seat and car safety, water and sun safety, fire safety, and firearm safety.
CounselingNot in the note with these choices
Discussed independence and rules, handling anger, school performance and activities, upcoming puberty, dental care, healthy weight and activity, screen time, car safety, sports and water safety, and firearm safety.
CounselingNot in the note with these choices
Discussed friends and limits, puberty and personal hygiene, school transitions and performance, dental care, healthy eating and breakfast, an hour of physical activity a day, online safety, car and sports safety, and firearm safety.
CounselingNot in the note with these choices
Discussed connection with family and friends, school, coping with stress, sleep, oral health, healthy eating and physical activity, body image, mood, avoiding tobacco, vaping, alcohol, and drugs, online safety, seat belts and helmets, sun protection, and firearm safety.
CounselingNot in the note with these choices
Discussed connection with family and friends, school and future plans, coping with stress, sleep, healthy eating and physical activity, body image, mood, avoiding tobacco, vaping, alcohol, and drugs, safe driving and never riding with an impaired driver, seat belts and helmets, and firearm safety.
CounselingNot in the note with these choices
Discussed connection with family and friends, school or work, coping with stress, sleep, healthy eating and physical activity, body image, mood, avoiding tobacco, vaping, alcohol, and drugs, safe driving, firearm safety, and the transition to adult health care.
Counseling
All forms, labs, immunizations, and concerns were reviewed and addressed. Screening questions, past medical and social history, medications, and the growth chart were reviewed. Age-appropriate anticipatory guidance was reviewed and printed in the after-visit summary. Caregiver expressed understanding and agreement with plan. Answered all questions.
What the sources cover
- Visit age (13 infant and early childhood visits; single years 5-21)
- Growth; BMI from 2 years
- Development; delays; abnormal ASQ or M-CHAT
- Newborn metabolic, hearing, CCHD screens verified
- Maternal depression 1, 2, 4, 6 months
- Developmental screening 9, 18, 30 months
- Autism screening 18, 24 months
- Vision (instrument 12, 24 months; acuity 3, 4, 5, 6, 8, 10, 12, 15 years)
- Hearing audiometry 4, 5, 6, 8, 10 years; high frequency once per adolescent band
- Blood pressure from 3 years
Show 9 more
- Fluoride varnish from tooth eruption through 5 years
- Hemoglobin at 12 months; lead at 12 and 24 months
- Lipids once at 9-11 and 17-21 years
- Confidential time; CRAFFT from 11; sudden cardiac arrest risk from 11
- Depression and suicide risk screen from 12
- STI screening; HIV once 15-21
- Immunizations per schedule; catch-up; declined
- Influenza from 6 months; nirsevimab in infancy
- Visit priorities (5 per visit)
Sources
- Bright Futures/AAP Recommendations for Preventive Pediatric Health Care (Periodicity Schedule)
- Hagan JF, Shaw JS, Duncan PM, eds. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th ed. AAP; 2017. Visit chapters as free…