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Lisa W. General, M.D. Dallas Developmental Pediatrics 7777 Forest Ln., B326 Dallas, TX 75230 9725668466 phone 9725668329 fax DEVELOPMENTAL PEDIATRIC HISTORY Date: Name of child: Date of birth: Age:
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How to fill out developmental pediatric history:

01
Start by collecting and organizing all necessary information about the child's medical history, including any previous diagnoses, treatments, and hospitalizations. This can be obtained from the child's parents or primary caregiver.
02
Record any developmental milestones achieved by the child, such as their age when they first started walking, talking, or other important developmental milestones. This can provide important insights into their overall development.
03
Document any concerns or observations made by the child's parents, teachers, or other caregivers regarding their behavior or developmental progress. This can include any delays in speech or language skills, problems with social interactions, or difficulties with fine or gross motor skills.
04
Include information about the child's diet, sleep patterns, physical activity levels, and any current medications or supplements they may be taking. These factors can have an impact on their development and can help to identify any potential causes or contributors to developmental delays.
05
Include information about the child's educational background, including any additional support or services they may be receiving, such as special education or therapy services. This can provide valuable context and help to identify any specific areas of concern or need.
06
It may be helpful to utilize standardized assessment tools or questionnaires to gather more detailed information about the child's development. These can include tools such as the Ages and Stages Questionnaires or the M-CHAT screening tool for autism. These assessments can provide additional data and help to identify any areas of concern that may require further evaluation or intervention.

Who needs developmental pediatric history?

01
Children who are experiencing developmental delays or difficulties. Developmental pediatric history can help healthcare professionals to identify any potential underlying causes or contributors to these delays and guide appropriate interventions and treatments.
02
Parents or caregivers seeking a comprehensive evaluation of their child's overall development. Developmental pediatric history can provide valuable information to assist in making informed decisions about the child's education, therapy, and overall care.
03
Healthcare professionals, such as pediatricians or developmental pediatricians, who are involved in the assessment and management of children with developmental concerns. Developmental pediatric history is an essential tool in gathering relevant information and determining appropriate next steps in evaluation and treatment planning.
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Developmental pediatric history is a detailed record of a child's growth and development from birth to present, including milestones, medical history, and any concerns or delays.
Parents or guardians of the child are typically the ones required to provide and file the developmental pediatric history with healthcare providers or specialists.
The developmental pediatric history can be filled out by providing information on the child's birth, growth, milestones, medical history, and any concerns or delays in development.
The purpose of developmental pediatric history is to track and monitor a child's growth and development, identify any potential issues or delays early on, and provide a comprehensive record for healthcare providers to reference.
Information such as birth details, growth measurements, developmental milestones, medical history, family history, and any concerns or delays in development must be reported on the developmental pediatric history.
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