Get Health Visit Report Form - Health Utah

Completing the Health Visit Report Form is essential for documenting a child's health visit. This guide aims to support you through the process of filling out this crucial form online, ensuring that all necessary information is accurately captured.

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

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the child's name, date of birth, and current age in the designated fields. Ensure that the details are accurate as this information is critical for identification.
3. Input the date of the visit and indicate who attended – whether it was a parent, foster parent, or caseworker – by selecting the appropriate option.
4. Provide the Medicaid ID number and the name of the medical provider and their facility, ensuring that all fields are filled accurately.
5. Select the type of visit from the predefined options such as Well Child Check (WCC), Sick Visit, Dental/Ortho, Mental Health/Therapy, or Medication Management, and specify any other type of visit as needed.
6. Record the child's height, weight, BMI, head circumference (if applicable), temperature, blood pressure, pulse, and respiratory rate in the specified fields.
7. Document any allergies the child has, using the provided options and including additional information as necessary.
8. List any lab tests that were performed during the visit, along with their results in the designated section of the form.
9. Complete the pertinent past history and review of systems/physical exam section, marking the fields as normal, deferred, or abnormal where applicable.
10. Describe the reason for the visit or diagnosis in detail, particularly if any abnormalities were noted during the examination.
11. Outline the treatment provided during the visit, detailing findings related to different body systems (e.g., Eyes, Ears, Nose) as specified.
12. Detail the follow-up care or referrals required and document any immunizations given during the visit.
13. Indicate whether the next appointment is on an as-needed (PRN) basis or a routine schedule.
14. Confirm if sufficient information was received for the care of the child by marking yes or no.
15. Finally, complete the medical provider's information, including name, facility, NPI number, and office phone number. Ensure that the provider signs and dates the form before final submission.
16. Once all fields are accurately completed, users can save changes, download, print, or share the form as needed.

Start completing your Health Visit Report Form online today to ensure comprehensive documentation of health visits.