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Rourke Baby Record - 18 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









Family















Environmental Health









Other







DEVELOPMENT

Social/Emotional











Communication Skills



















Motor Skills







Adaptive Skills









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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