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Ginny Fullerton, Ph.D. 4131 Spice wood Springs Road, P2 Phone: 512.535.6088 email: Fullerton gmail.com CHILD AND ADOLESCENT HISTORY INTAKE From This information is confidential. Please complete as
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How to fill out child and adolescent history
How to fill out child and adolescent history:
01
Start by gathering basic information such as the child's full name, date of birth, and contact information.
02
Next, document the child's medical history, including any previous illnesses, surgeries, or hospitalizations.
03
Provide a detailed account of the child's developmental milestones, including when they started walking, talking, and achieving other significant developmental milestones.
04
Include information about the child's immunization history, noting which vaccines they have received and when.
05
Document any known allergies or sensitivities the child may have, including any adverse reactions to medications or substances.
06
Include information about the child's family history, including any significant medical conditions or genetic disorders that run in the family.
07
Discuss the child's social and emotional development, including their relationship with parents, siblings, and peers. Include any relevant information about the child's behavior or emotional well-being.
08
Note any medications or supplements the child is currently taking, as well as dosage and frequency.
09
Finally, include any additional information or observations that may be relevant to the child's overall health and well-being.
Who needs child and adolescent history?
01
Pediatricians and other healthcare professionals who provide medical care to children and adolescents need a comprehensive child and adolescent history to better understand the patient's medical background and guide their healthcare decisions.
02
Parents and guardians can benefit from having a clear record of their child's medical history, as it helps them keep track of important information and communicate effectively with healthcare providers.
03
Schools, daycare centers, and programs that work with children may require a child and adolescent history form to ensure the child's health and safety while under their care.
04
Researchers and academics studying child development and healthcare may also use child and adolescent history to analyze trends, identify risk factors, and develop strategies for improving the health and well-being of children and adolescents.
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What is child and adolescent history?
Child and adolescent history is a record of a child's medical, developmental, and social history from birth through adolescence.
Who is required to file child and adolescent history?
Parents, guardians, or healthcare providers are required to file child and adolescent history.
How to fill out child and adolescent history?
Child and adolescent history can be filled out by providing detailed information about the child's health, growth, development, and any relevant medical history.
What is the purpose of child and adolescent history?
The purpose of child and adolescent history is to provide a comprehensive overview of a child's health and development to aid in medical care and decision making.
What information must be reported on child and adolescent history?
Information such as medical conditions, allergies, medications, developmental milestones, family medical history, and any significant events or traumas should be reported on child and adolescent history.
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