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  • Pediatric Health History Form Child's Name: Date Of Birth ...

Get Pediatric Health History Form Child's Name: Date Of Birth ...

Pediatric Health History Form CHILD S NAME: DATE OF BIRTH: AGE: CHILD'S PREVIOUS DOCTOR/PRIMARY CARE PROVIDER: PRESENT HEALTH CONCERNS: MEDICINES/VITAMINS: HERBS/HOME REMEDIES: ALLERGIES/REACTIONS.

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The collection of objective data includes the nurse doing a baseline measurement of the child's height, weight, blood pressure, temperature, pulse, and respiration.

In general, however, the pediatric population includes patients age “birth to 16 years, including age groups often called neonates, infants, children, and adolescents” (21 CFR 201.57(f)(9)).

History of present illness (HPI) The details of the present illness are recorded in chronological order. Duration and a brief description of current signs, symptoms, and treatment, if any. If the child is receiving medication, record the name of the drug, dose, frequency of administration, and response to medication.

The pediatric past medical history (PMH) includes the prenatal and birth histories, the immunization history, and a history of growth and development. Pediatric nutritional assessment must be tailored to the child's age.

The basic components of a pediatric history are as follows: history of presenting illness, past history including prenatal, birth, and postnatal history, past medical history, surgical history, growth and developmental, medications, allergies, immunizations, family history, social history and review of systems.

The pediatric past medical history (PMH) includes the prenatal and birth histories, the immunization history, and a history of growth and development. Pediatric nutritional assessment must be tailored to the child's age. A developmental approach is necessary when obtaining a pediatric sleep assessment.

An example of pediatric cohorts: Neonates -- birth to age less than 1 month. Infants -- age 1 month to less than 2 years. Children -- ages 2 to less than 12 years. Adolescents -- ages 12 to less than 17 years.

In general, a medical history includes an inquiry into the patient's medical history, past surgical history, family medical history, social history, allergies, and medications the patient is taking or may have recently stopped taking.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232