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Boulevard Center Pediatrics Shields Godel MD 4201 Dale Blvd Dale City, VA 22193Phone: (703) 670-0300 Fax: (703) 670-6759 www.boulevardcenterpediatrics.com 24 MONTH VISIT Today s Date: Immunizations
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How to fill out 24 month visit-revised 1-16-14:

01
Start by gathering all the necessary documents and forms required for the visit. This may include the 24 month visit-revised 1-16-14 form itself, any medical records or test results, and identification documents.
02
Carefully read through the instructions provided on the form. Familiarize yourself with the sections and fields that need to be completed. Pay attention to any specific guidelines or requirements mentioned.
03
Begin filling out the form by providing the required personal information. This may include the child's full name, date of birth, address, and contact details. Ensure that all the information provided is accurate and up-to-date.
04
Move on to the medical history section of the form. Here, you will be asked to provide information about any previous illnesses, allergies, vaccinations, and medications that the child has received. Provide as much detail as possible to ensure accurate records.
05
Fill in the developmental milestones section of the form. This may involve documenting the child's growth and development progress, such as their ability to sit, crawl, walk, speak, etc. Be truthful and provide accurate information based on your observations.
06
Proceed to the physical examination section. Here, you may need to record the child's height, weight, blood pressure, visual acuity, and other relevant measurements. Ensure that all measurements are taken accurately and recorded correctly on the form.
07
If required, provide additional information or comments in the spaces provided. This may include any concerns or observations you have regarding the child's health or development. It is essential to communicate any pertinent information that can assist the healthcare provider in providing appropriate care.
08
Once you have filled out all the necessary sections of the form, review it thoroughly. Double-check for any errors or missing information. Make sure that all the entries are legible and can be easily understood.
09
Sign and date the form as required. If there are multiple sections that need signatures, ensure that each required party signs accordingly.

Who needs 24 month visit-revised 1-16-14?

Parents or guardians of children who are 24 months old or approaching their second birthday may need to fill out the 24 month visit-revised 1-16-14 form. This form is typically used in medical settings to gather information about a child's health, development, and any concerns the parents may have. It helps healthcare providers assess the child's well-being and provide appropriate medical care or interventions if necessary. The form may be required as part of routine check-ups or when seeking medical advice for the child's growth and development.
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It is a required visit form that provides a comprehensive review of the progress and development of a child at 24 months of age.
Parents or guardians of the child, as well as healthcare providers, are required to fill out the form.
The form must be completed by providing detailed information about the child's growth, development, and any concerns or observations.
The purpose of the form is to track the child's progress and ensure they are meeting developmental milestones at 24 months of age.
Information about the child's physical and cognitive development, as well as any concerns or observations, must be reported.
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