Get Pediatric History & Physical Form.docx

Filling out the Pediatric History & Physical Form online is a crucial step in preparing for your child's upcoming surgery. This guide provides detailed instructions to help you complete the form accurately and efficiently.

Follow the steps to complete the Pediatric History & Physical Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with the header section where you will enter the name, date of birth (DOB), surgeon's name, type of surgery, anesthesia type, and the date of the surgery.
3. Proceed to the Pediatric Medical History & Physical Exam section, ensuring the form is filled out within 30 days before the surgery.
4. Fill in the Past Medical History section, detailing any hospitalizations or illnesses within the last six months along with dates for each occurrence.
5. Address any other relevant medical conditions by checking the appropriate boxes, including any history of hypertension, asthma, developmental delays, or other listed conditions.
6. Complete the surgical history by providing details about the patient's previous surgeries if applicable.
7. In the Physical Exam section, input all necessary signs such as heart rate (HR), blood pressure (BP), respiratory rate (RR), temperature, height (Ht), and weight (Wt).
8. Assess and note the patient's orientation status and complete the evaluations for HEENT, cardiovascular, lungs, abdomen, and neurological health, marking normal or not applicable (N/A) as necessary.
9. Fill out the Special Notes section with any additional information that may be relevant to the health and safety of the patient.
10. Conclude the form by signing and dating it, ensuring that the reviewing physician or surgeon completes their signature as well.
11. Once you have filled out the form completely, review all information for accuracy. You can then save changes, download, print, or share the completed form as needed.

Start filling out your Pediatric History & Physical Form online today!