Get Well Child 12 Months Name: Visit Date: / / Language: P: Dob: / / Rr: Age: Months H

The WELL CHILD 12 Months form is an essential document used to assess a child's health and development at the one-year mark. This guide will provide step-by-step instructions on how to accurately fill out the form online, ensuring all necessary information is properly recorded.

Follow the steps to efficiently fill out the WELL CHILD 12 Months form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the child's name in the 'Name' field, ensuring correct spelling to avoid any identification issues.
3. Fill out the 'Visit Date' section by selecting the appropriate date from the calendar feature provided.
4. Choose the preferred language for the visit from the 'Language' field, indicating if it is English or another language.
5. Record the child's date of birth in the 'DOB' section, ensuring the format is consistent with the field's requirements.
6. Indicate the child's age in months in the 'Age' field, reflecting the child's current age.
7. Provide the child's height and weight in the respective fields, using inches for height and pounds for weight.
8. Document any allergies the child may have in the 'Allergies' section to ensure proper care.
9. Complete the 'INTERVAL HISTORY' section by noting the child's diet, including breastfeeding or solid food intake.
10. Discuss and check off any education or anticipatory guidance topics that were covered during the visit.
11. Fill out the 'PHYSICAL EXAMINATION' section with observations about the child's physical condition and development.
12. Provide evaluation comments in the 'ASSESSMENT' section and list any necessary orders or plans for the child's care.
13. Finally, review all the entered information for accuracy. Once complete, save changes and choose to download, print, or share the form as required.

Complete the WELL CHILD 12 Months form online to ensure your child's health needs are met.