Get (birth Through Age 17)

This guide provides clear and supportive instructions for filling out the Birth Through Age 17 form online. It is designed to assist users of all experience levels in accurately completing the form to document your child's medical history effectively.

Follow the steps to complete the form accurately and efficiently.

1. Press the ‘Get Form’ button to acquire the necessary form and open it in your preferred editing tool.
2. Enter today’s date, child's name, and date of birth in the specified fields. Ensure all entries are accurate to avoid discrepancies.
3. Fill in the parents' names, occupations, and their daytime phone numbers. This information assists in establishing contacts for any follow-up.
4. List the names and dates of birth of the child's siblings, if applicable. This may be relevant for family medical history.
5. Indicate the daytime childcare arrangement by circling whether it is a parent, daycare center, babysitter/nanny, or school. Include the name and phone number of the caretaker, if applicable.
6. In the birth history section, document any medical problems experienced during pregnancy. Circle whether your child was fed by breastmilk or formula, and provide the child's birth weight.
7. Select the method of delivery by circling the appropriate option: spontaneous vaginal, C-section, or forceps/vacuum assisted. Also, list any problems that occurred during the newborn period.
8. For family history, check relevant medical issues and note the relationship of family members with those conditions.
9. In the social history section, circle 'Y' or 'N' to indicate if there is tobacco exposure at home or guns present.
10. Proceed to document any significant medical problems your child has had, along with details of hospitalizations or surgeries, and list any severe injuries or broken bones.
11. List current medications, including both prescription and over-the-counter, followed by any allergies your child may have.
12. In the nutrition and feeding history section, note any past or present concerns regarding your child's eating habits.
13. Indicate whether your child has met normal developmental milestones and provide explanations for any behavioral concerns if applicable.
14. Fill in the school history, specifying any concerns regarding school performance and listing extracurricular activities or sports.
15. For vaccination history, provide a copy of prior vaccinations and explain if any vaccinations have been refused.
16. Complete the preventive care section by indicating any sleep problems, whether your child sees a dentist, and if there are concerns regarding substance abuse or risky behaviors.
17. Once all sections are complete, review the form for accuracy, make any necessary adjustments, and then save your changes. You may also download, print, or share the completed form as needed.

Complete the Birth Through Age 17 form online today for efficient record-keeping of your child's medical history.