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1114 Year Health Maintenance Form (student to complete) Patient Name What School do you attend? What grade are you in×entering? How are your grades in school? (circle all that apply) As BS Cs DS
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How to fill out 11-14 year health maintenance
How to fill out 11-14 year health maintenance:
01
Gather necessary information: Before filling out the form, make sure you have collected all the relevant information about the individual aged 11-14 years. This may include their personal details, medical history, immunization records, and any specific concerns or conditions they may have.
02
Complete personal information: Begin by filling out the personal information section of the form, which typically includes the person's full name, date of birth, address, and contact details. Provide accurate and up-to-date information in this section.
03
Medical history: In the health maintenance form, there is usually a section dedicated to recording the individual's medical history. Take your time to accurately fill out this section by listing any existing medical conditions, previous surgeries, allergies, or ongoing medications. Be as detailed as possible to paint a comprehensive picture for the healthcare provider.
04
Immunization record: Check the immunization record section of the form and ensure that all the necessary vaccinations for individuals aged 11-14 years have been provided. If any immunizations are missing or not up to date, consult with a healthcare professional to schedule the required vaccinations.
05
Developmental milestones and concerns: Health maintenance forms often include sections to monitor the individual's developmental milestones and any concerns regarding their growth and development. Answer the questions related to physical, cognitive, and social-emotional milestones based on your observations, and note any specific concerns you might have.
06
Additional screenings or tests: Some health maintenance forms may require additional screenings or tests, depending on the individual's age and risk factors. Follow the instructions provided and answer these sections accurately. If you are unsure about any screening or test, seek guidance from a healthcare professional.
Who needs 11-14 year health maintenance?
01
Adolescents aged 11-14 years: The target audience for 11-14 year health maintenance includes individuals who fall within the age range of 11 to 14 years. This period is critical for growth, development, and establishing healthy habits, making regular health maintenance essential.
02
Parents and guardians: Parents or guardians of adolescents aged 11-14 years should be involved in filling out the health maintenance form. They play a crucial role in providing accurate information about the individual's medical history, immunizations, and developmental concerns.
03
Healthcare providers: Health maintenance forms are an important tool for healthcare providers to assess and monitor the health and well-being of individuals aged 11-14 years. Filling out these forms accurately helps healthcare providers create a comprehensive picture of the individual's health status and identify any areas that require attention or further evaluation.
Remember, always consult with a healthcare professional for specific guidance and instructions when filling out any health maintenance forms.
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