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Rourke Baby Record - 4 years

Gestational Age: 

Birth Length: cm

Birth Weight: g

Birth Head Circumference: cm



Past problems/Risk factors :

Family history :



GROWTH

Height :

Weight :

BMI :



PARENT/CAREGIVER CONCERNS :





NUTRITION











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

Injury Prevention

















Behaviour















Family















Environmental Health









Others











DEVELOPMENT















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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