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Get CO General Health Appraisal Form 2007-2024

Normal qHearing: qNormal qAbnormal qDental: qNormal qAbnormalRecommended Follow-up________________________________________________________________________________________ Provider Signature Next Well Visit: q Per AAP guidelines* or q Age__________ This child is healthy and may participate in all routine activities in school sports, child care or camp program. Any concerns or exceptions are identified on this form. Office Stamp Or write Name, Address, Phone, # ________________________________.

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