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PEDIATRIC MEDICAL HISTORY
PATIENTNAME:PRESENTHEALTHCONCERNS:
BIRTHHISTORY
DateofBirth:
Birthright:
Birthplace(Hospital, City):
Werethereanyproblemsduringpregnancy?
Werethereanyproblemsduringlabor?
MEDICALHISTORY
Hasyourchildeverhadany:
Seriousorchronicillnesses?
Surgeries?
Overnight
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How to fill out pediatric medical history
How to fill out pediatric medical history
01
Gather all necessary information such as child's name, date of birth, and contact information.
02
List any existing medical conditions or allergies the child may have.
03
Document any past surgeries or hospitalizations.
04
Include information about any medications the child is currently taking or has taken in the past.
05
Note any family history of medical conditions that may be relevant.
06
Record any developmental milestones and growth charts.
07
Include information about the child's immunization history.
08
Make sure to update the medical history regularly as new information becomes available.
Who needs pediatric medical history?
01
Pediatricians
02
Primary care physicians
03
Specialists who provide care to children such as pediatric cardiologists or pediatric oncologists
04
School nurses
05
Childcare providers
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What is pediatric medical history?
Pediatric medical history is a detailed record of a child's health information which includes past illnesses, treatments, medications, allergies, surgeries, and family medical history.
Who is required to file pediatric medical history?
Parents or guardians are typically required to fill out pediatric medical history forms for their children.
How to fill out pediatric medical history?
Pediatric medical history forms can be filled out by providing accurate and detailed information about the child's health, including any past illnesses, treatments, medications, allergies, surgeries, and family medical history.
What is the purpose of pediatric medical history?
The purpose of pediatric medical history is to provide healthcare providers with important information about a child's health background, which can help in making proper diagnoses, developing treatment plans, and ensuring the child receives appropriate care.
What information must be reported on pediatric medical history?
Information that must be reported on pediatric medical history includes past illnesses, medications, allergies, surgeries, family medical history, and any other relevant health information.
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