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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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