Well-Child Visit: 18 months Age mo c g’s name



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EPSDT

 Hx/Nutr/Devel

 Unclothed PE

 Labs


Health Educ

 Vision Screen

 Hearing Screen

 Immunizations

 Dental Referral


Well-Child Visit: 18 months Age______mo

C

G’s name: © Kevin Marks MD, 2012; Last Revised 2-22-2012






o Mom o Grandparent

Who is at the WCV? o Dad o Foster parent

o Sibling(s) o Other Caregiver

Health or growth concerns?

1.

2.

3.

Interval Hx? _____



Breastfeeding o Yes o No

Cow’s milk? o Yes o No Whole or 2%? oz/day

Fe-rich cereal 2x qd? o Yes o No

Meats, fish, eggs, soy? o Yes o No

Vegetables, fruits? o Yes o No

Age-appropriate finger foods? o Yes o No Fruit juice, sugars? o Yes o No

Elimination concerns? o Yes o No ____________________



Concerns?_______________


__________________________________________________ General developmental & ASD screenings (per AAP)

Administered: o ASQ o PEDS o PEDS:DM

Interpretation: o Typical/ observe o Atypical/ action needed

Domains: o expr. lang. o recept. lang. o cognitive

of concern o fine motor o gross motor o SE/ behavior

o self-help/ adaptive o other



Administered: o M-CHAT circle if: ( + ) or ( - ) o Other

Circle if: No bottle in bed ; Brushing; Fluoride

o Referred to dentist



o Fluoride varnish + handout

__________________________________________



Updated in Problem List / EMR

________



__________________________________________________

Tobacco exposure? o Yes o No DV? oYes o No



o Cap Hemogram or HemoCue (If Hgb<11 or if high-risk for iron defic. then venipuncture CBC, ferritin, CRP)

o Blood lead level

o TB Skin Test if at risk per TB questionnaire



Cover test: o No motion

Corneal light reflex: o Symmetric

Hearing: o Turns to voice o Startles



Vitals & Growth Parameters

T C/F ax/rect/tymp P R BP /

HC cm ( %) Length cm ( %)

Wt kg ( ___ %) wt / ht ratio ____ %

GEN

HEENT

Chest/Lungs

CV/Heart

ABD

GU

Skin

MSK/Spine

Neuro


Parent-Child Interaction

Other:





Growth: o typical o obese o overweight o underweight/ FTT

Development & Behavior: see above

Other: see EMR problem list



__________________________________________________

__________________________________________________

__________________________________________________



18 mo WCV handout (Bright Futures: Early Childhood)



ROR book & literacy counseling

o “Healthy Habits” / obesity prevention handout + counseling



o EI referral & care coordination phone #

o Positive parenting support group or counseling

o Refer for multi-speciality dev-behav. evaluation

o Fluoride 0.25mg + MTV w/ iron & Vit D 600 IU PO daily






  • Praise for good behavior; consistent, calm, immediate discipline; choices with 2 options; reinforce limits

  • Talk about what you see; use simple words to describe pictures in books; teach words about feelings; read daily

  • Anticipate anxiety/clingy behavior in new situations

  • No bottle in bed; consistent bedtime & waking up routine
  • Home safety: stair gates; operable window guards if >2nd story room; prevent burns; install smoke detectors


Refer to EMR for vaccines given, CDC handouts given

o Vaccine counseling

o Refusal to vaccinate AAP form signed



o Next routine well-child visit



o Early return OV

o SE (ASQ:SE) screening needed (per AAP)

o ASD assessment/ M-CHAT Follow-up Interview needed




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