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Rourke Baby Record - 15 months

Gestational Age: 

Birth Length: cm

Birth Weight: g

Birth Head Circumference: cm



Past problems/Risk factors :

Family history :



GROWTH (Correct age until 24-36 months if < 37 weeks gestation)

Lenght :

Weight :

Head circ. :



PARENT/CAREGIVER CONCERNS :





NUTRITION



















EDUCATION AND ADVICE (repeat discussion of items is based on perceived risk or need)

Injury Prevention























Behaviour and Family Issues





























Environmental Health









Others Issues













DEVELOPMENT

(Inquiry and observation of milestones. Tasks are set after the time of typical milestone acquisition. Absence of any item suggests consideration for further assessment of development. Correct for age if < 37 weeks gestation)















PHYSICAL EXAMINATION



















PROBLEMS AND PLANS/CURRENT AND NEW REFERRALS

(e.g. medical specialist, dietitian, speech, audiology, PT, OT, eyes, dental, social determinants resources) :





INVESTIGATIONS/SCREENING AND IMMUNIZATION (discuss immunization benefits and pain reduction strategies)









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