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THREE TO FOUR YEAR WELL CHILD VISIT Hirsch Holistic Family Medicine 1017 4th Ave E, #6 Olympia, WA 98506 800 4800299 fax (800 4800299 Patient names: Date Age Accompanied by: Birthdate PARENT SECTION:
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How to fill out a 3-4yr well child:

01
Gather necessary information: Collect all relevant medical records, previous well-child checkup forms, and any immunization records for the child.
02
Complete demographics: Fill out the child's name, date of birth, address, and contact information accurately. Provide insurance details if required.
03
Update medical history: Ensure that the child's medical history is up to date by answering questions regarding previous illnesses, hospitalizations, surgeries, medications, allergies, and any chronic conditions. Include all relevant details.
04
Developmental milestones: Assess the child's developmental progress by documenting milestones such as language skills, social interactions, motor skills, and cognitive abilities. Note any concerns or delays.
05
Physical examination: Document the child's height, weight, and head circumference. Assess the child's overall health, vision, hearing, and any physical abnormalities. Record vital signs such as blood pressure, heart rate, and temperature.
06
Immunizations: Review the child's immunization records and provide any necessary vaccines according to the recommended schedule. Document the vaccines administered during the visit.
07
Nutritional assessment: Inquire about the child's eating habits, diet, and preferences. Provide guidance on age-appropriate nutrition and address any concerns regarding the child's weight or dietary restrictions.
08
Behavioral and social development: Observe the child's behavior, social interactions, and communication skills. Assess their ability to follow instructions and interact with others. Address any concerns related to behavior or development.
09
Safety guidance: Provide parents or caregivers with information regarding child safety measures, accident prevention, and childproofing the home. Offer guidance on car seat usage, helmet use, and other safety practices.
10
Additional screenings: Conduct any necessary screenings for hearing, vision, dental health, blood tests, or lead exposure, as recommended by healthcare guidelines or based on specific concerns.

Who needs a 3-4yr well child:

01
Children aged 3 to 4 years: Well-child visits are recommended for children in this age group to monitor their growth, development, and overall health. These visits provide an opportunity for healthcare professionals to assess and address any emerging health issues or developmental concerns.
02
Parents or caregivers: Attending a well-child visit allows parents or caregivers to receive guidance on their child's health, nutrition, safety, and development. It offers an opportunity to discuss any concerns or ask questions regarding the child's well-being.
03
Pediatricians or healthcare providers: Well-child visits for children aged 3 to 4 years are typically conducted by pediatricians or healthcare providers. These visits allow professionals to assess the child's physical, cognitive, and social development, provide necessary vaccinations, address parental concerns, and offer appropriate guidance for the child's continued growth and well-being.
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The 3-4yr well child visit is a routine checkup recommended for children between the ages of 3 and 4 years old to monitor their health and development.
Parents or guardians of children aged 3 to 4 years old are required to schedule and attend the well child visit.
To fill out the 3-4yr well child visit, parents or guardians need to provide information about the child's medical history, current health status, and any concerns or questions they may have for the healthcare provider.
The purpose of the 3-4yr well child visit is to track the child's growth and development, address any health concerns or issues, and provide preventive care to ensure the child's overall well-being.
The information reported on the 3-4yr well child visit typically includes the child's weight, height, blood pressure, vision and hearing screenings, developmental milestones, vaccinations, and any concerns or questions from the parents or guardians.
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