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PEDIATRIC MEDICAL HISTORY FORM Name: Parent(s) Name(s): DOB: Adopted: Y N School Name: Grade: Names & Ages of all other people living in the household: Pets?: Please check if you currently have or.
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Applicable FAQ
The HEENT examination will include assessing the HEENT for symmetry, and color; hair distribution to scalp, eyebrows, and eyelashes; hydration status of the mucus membranes to the nose and mouth; the number and condition of teeth, palate structure and uvula placement and color of lips and buccal membrane.
The basic components of a pediatric history are as follows: history of presenting illness, past history including prenatal, birth, and postnatal history, past medical history, surgical history, growth and developmental, medications, allergies, immunizations, family history, social history and review of systems.
A full physical exam will be performed along with hearing, vision and oral health screenings. The vision screening likely will involve an eye chart. The pediatrician also will assess fine and gross motor skills, and observe your child's speech for any difficulties.
Along with checking your child's vital signs and monitoring their height and weight your pediatrician will also check hearing, eyesight, respiration, cardiac activity and reflexes. A physical exam will check all systems of your child's body to make sure that everything is functioning properly.
The exam looks at a baby's skin and other physical features, plus the baby's movement and reflexes. The physical maturity part of the exam is done in the first 2 hours of birth. The movement and reflexes part of the exam is done within 24 hours after birth.
Visual inspection — The initial part of the head, eyes, ears, nose, and throat (HEENT) examination includes assessment of the head shape (figure 1), presence and distribution of hair, scalp defects, abnormalities of sutures, abnormal lesions or protuberances, lacerations, and abrasions or contusions.
Physical Exam To check your baby's body, the doctor or nurse will: Measure height, weight, and the size of your baby's head. Take your baby's temperature. Check your baby's eyes and hearing.
Inspection – Assess the head and face for external abnormalities such as erythema in the presence of infection, or bruising and deformity in the event of trauma. In the HEENT exam, inspection also includes visualization of the ear canals and tympanic membrane with an otoscope as well as the pharynx.
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