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QUESTION
Create a child health history template for your personal use.
Subject | Nursing | Pages | 4 | Style | APA |
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Answer
Child Health History Template
Name:_________________ Age: ______________ Gender: _________________ First Visit:__________ Subsequent Visit: ________________ Date of Last Visit:_______________ |
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Current Health Concerns: __________________________________________________________________________________________________________________________________________________ Update on Previous Health Concerns: __________________________________________________________________________________________________________________________________________________ |
Prenatal and Birth History: __________________________________________________________________________________________________________________________________________________ List Childhood Illnesses or Injuries: __________________________________________________________________________________________________________________________________________________ Hospitalization History: __________________________________________________________________________________________________________________________________________________ Surgical History: __________________________________________________________________________________________________________________________________________________ List of Allergies: __________________________________________________________________________________________________________________________________________________ Missing Immunizations: __________________________________________________________________________________________________________________________________________________ Current Medications: __________________________________________________________________________________________________________________________________________________ |
Prior Screening: _________________________________________________________________________ Invasive Procedures: _________________________________________________________________________ Lab Tests: _________________________________________________________________________ Results from above procedures: __________________________________________________________________________________________________________________________________________________ |
Sleep, nutrition, and exercise habits: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________ Developmental Milestones Achieved: __________________________________________________________________________________________________________________________________________________ |
Genetic Illnesses in Family: _________________________________________________________________________ Cultural Practices of Family: _________________________________________________________________________ Are Parents using drugs?: ___________ List them: _____________________________ |
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Any Signs of child neglect: _________________________________________________________________________ Any signs of child abuse: _________________________________________________________________________ Any Lack of basic needs: _________________________________________________________________________ |
References
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