Get Health Visit Report Form 2020-2025

The Health Visit Report Form is an essential document for recording key details about a child's health visit. This guide will provide you with a step-by-step approach to filling out this form online effectively and accurately.

Follow the steps to fill out the Health Visit Report Form online.

1. Press the ‘Get Form’ button to acquire the Health Visit Report Form and open it in the online editor.
2. Fill in the child’s name, date of birth, and current age in the designated fields.
3. Enter the date of the visit and the Medicaid ID number as prompted in the respective fields.
4. Indicate who is attending the visit by selecting one of the following options: Parent, Foster Parent, Tracker, or Other. Enter the caseworker's name if applicable.
5. Select the type of visit from the options provided: WCC, Sick Visit, Dental/Ortho, Mental Health/Therapy, Med Mgmt., or Other. Specify if Other is chosen.
6. Complete the section titled 'PLEASE PRINT' by entering the height, weight, and BMI values. Provide the occipital frontal circumference if required.
7. Fill in the diagnosis section with relevant information. Provide vital signs including temperature, blood pressure, pulse, and respiratory rate.
8. Conduct and document a vision screening by entering the appropriate visual acuity results for each eye.
9. List any lab tests performed and their results in the specified section.
10. Provide a summary of the pertinent past history and include a detailed treatment plan, along with any medications prescribed.
11. Document any known allergies and additional health concerns as specified.
12. Utilize the Review of Systems/Physical Exam section to indicate normal, deferred, or abnormal findings in each category by circling the appropriate letter.
13. Complete the follow-up/referrals section. Indicate if the next available appointment is scheduled or if it is urgent.
14. List any immunizations given during the visit and mark the ones that are applicable.
15. State whether you had enough information for the care of the child by selecting 'YES' or 'NO.'
16. Finally, ensure the medical provider's name, NPI number, facility, office phone number, and signature are clearly printed and dated.
17. After reviewing the completed form, save your changes, download, print, or share the form as needed.

Start filling out the Health Visit Report Form online today to ensure accurate health documentation.