Get Dss-5209-ia. Health Summary Form - Well-visit

The DSS-5209-ia. Health Summary Form - Well-Visit is a crucial document for recording health information during well visits for children and youth in the custody of the Department of Social Services. This guide provides clear, step-by-step instructions to help users complete this form accurately and efficiently online.

Follow the steps to complete the health summary form effectively.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the date of visit in the designated field to ensure accurate record-keeping.
3. Input the patient’s name and date of birth, formatted as month/day/year, to identify the individual being assessed.
4. Provide the patient's Medicaid ID number, ensuring this information is kept confidential.
5. Attach the visit summary that includes vital signs, growth parameters, and physical examination findings.
6. Complete the screenings section, indicating vision and hearing results, and responding to developmental assessments as applicable.
7. Detail any current health conditions or issues, whether acute or chronic, in the provided space.
8. List any medications provided or prescribed during the visit, ensuring accurate dosage and administration details.
9. Record any additional concerns that may arise at home, school, or within the community.
10. Document immunizations administered during this visit and any known allergies.
11. If there are any referrals needed for specialty care, provide the necessary details and address those needs.
12. State whether a psychotropic medication review has been requested by indicating 'yes' or 'no'.
13. Outline the treatment plan, which should include follow-up appointments, lab testing, and needed immunizations.
14. Include any comments or instructions intended for DSS, caregivers, or school personnel to ensure proper follow-up.
15. Finally, enter the next well-visit date and time, and ensure that the provider name and signature are added for validation.
16. After filling out all sections, you can save your changes, download, print, or share the completed form as needed.

Complete the DSS-5209-ia. Health Summary Form - Well-Visit online today to ensure comprehensive health tracking.