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Get 5 Early Childhood Pre-K Health Record Supplement

Ility: To Be Completed By The Physician 1. Type Screening 2. Date Completed 3. Results 4. Recommendations/Follow up Head Circumference (up to 2yrs old) Normal Abnormal Normal Abnormal Hgb/Hct Lead Normal Abnormal BMI ( 2 years old) Normal Counsel Developmental Screening Tool: PEDS ASQ Other 5. Medical Conditions Allergies/Sensitivities None List: No Concern Concern 7.

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