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Rourke Baby Record - 2 weeks

Gestational Age: 

Birth Length: cm

Birth Weight: g

Birth Head Circumference: cm

Discharge Weight: g



Past problems/Risk factors :

Family history :



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

Lenght :

Weight (regains BW 1-3 weeks) :

Head circ. :



PARENT/CAREGIVER CONCERNS :





NUTRITION





Stool pattern and urine output :



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)





Miscellaneous notes :



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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