Health Assessment of the School-Age Child (5-12 Years)
The Worksheet
All children should have a yearly health maintenance visit. By six years of age, most children can provide reasonably accurate medical information, and it is a good idea to talk to the child as well as to the parent.
If this is patient is new to you, obtain the complete family medical and social history. Use the School-Age Child Health Maintenance guide to complete the age-related history and physical examination.
Click on the highlights below for more detail or to branch to a hyperlink within the popup. You can get to a print version of the form on the side bar.
Interim History since last well child visit:
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Concerns to discuss today: OLD CARTS, present history in logical, chronological order
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Review Past Medical History/Family Medical History (PMH/FMH): Include appropriate information, including dates of hospitalizations/surgeries if possible, ages/illnesses of relatives
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Medications: Include names, dosages, and frequencies of prescription, over-the-counter, and alternative therapies
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Allergies: Include drug, food, and environmental allergies and patient's reaction
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Social History: Include who lives at home, who cares for the child/daycare, smoke exposure, pets
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Nutritional Assessment:
Liquid intake: (water/milk/other such as juice and sugary drinks) |
Snack choices
Urination: Stooling:
Parent concerns regarding nutrition |
Mental Health Assessment: Include: Sleep, Family stresses, Parenting needs, Child abuse risk, Behavior challenges
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Developmental Assessment:/Ages and Stages Questionnaire: School performances, Extra curricular activities, Communication effectiveness (verbal/written), Interpersonal relationships |
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Review of Systems:
Vital Signs: Weight (percentile):_______,____% BMI: :_______,____% Temperature:_________ |
General appearance Oropharynx Cardiovascular Abdominal Genitalia Musculoskeletal/hips Skin Other |
Screening: Vision,Hearing, Hemoglobin, Tuberculosis questionnaire
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Health Education/Anticipatory Guidance: Nutritian: Growth charts, Healthy diet Safety: Smoke detectors, Car seats/booster seats, Ingestions, Choking, Stranger safety, Internet safety, Firearms Health Promotion: Immunizations Family: Siblings, Address concerns |
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Immunizations indicated today: |
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Labs (hemoglobin/lipids/other) indicated today: Based on screening and Texas Health Steps recommendations |
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Next Well Check : |
Quickchecks: Developmental Milestones