General Practitioner Template
Well Child Report Form
A professional General Practitioner template for healthcare professionals.
About this template
Looking for a simple way to document a child's health? A Well Child Report template is a comprehensive form used by GPs and paediatricians to record a child's health, development, and immunisation status. This template covers everything from developmental milestones to physical examinations, providing a complete overview of a child's well-being. With Heidi, this template can be quickly populated from a consultation transcript, saving valuable time and ensuring accurate record-keeping.
Preview template
Well Child Report
Child's Information
Name: Lily-Rose Smith
Date of Birth: 12 July 2022
Age: 2 years 3 months
Gender: Female
Parent/Guardian Information
Name(s): Sarah and David Smith
Contact Number: 07700 900123
Email: sarah.smith@email.com
Date of Examination: 1 November 2024
Reason for Visit: Routine 2-year check-up.
Developmental Milestones
Gross Motor: Walks, runs, and climbs stairs with assistance.
Fine Motor: Scribbles, stacks blocks, and attempts to feed self.
Language/Communication: Speaks in two-word sentences, understands simple instructions.
Social/Emotional: Plays alongside other children, shows affection.
Cognitive: Recognizes familiar objects and people.
Physical Examination Findings
General Appearance: Alert and active, well-nourished.
Head: Head circumference within normal range.
Eyes: Vision appears normal.
Ears: Tympanic membranes clear.
Nose/Throat: No signs of infection.
Cardiovascular: Regular heart rate and rhythm.
Respiratory: Clear breath sounds.
Abdomen: Soft, non-tender.
Genitourinary: Normal external genitalia.
Musculoskeletal: Normal range of motion.
Skin: No rashes or lesions.
Neurological: Gross neurological function intact.
Growth Parameters
Weight: 12.5 kg (50th percentile)
Height/Length: 88 cm (50th percentile)
BMI (if applicable): 16.1 (50th percentile)
Immunization Status: Up-to-date on all recommended vaccinations.
Screening Tests
Vision Screening: Passed vision screening.
Hearing Screening: Passed hearing screening.
Developmental Screening: Completed and within normal limits.
Anticipatory Guidance/Counselling
Nutrition: Discussed healthy eating habits and portion sizes.
Safety: Reviewed car seat safety and home safety measures.
Sleep: Discussed consistent bedtime routine.
Discipline/Behavior: Encouraged positive reinforcement.
Developmental Promotion: Encouraged reading and interactive play.
Oral Health: Discussed importance of brushing and first dental visit.
Concerns/Recommendations
Parental Concerns: No specific concerns raised.
Provider Recommendations: Continue routine check-ups and vaccinations.
Next Well Child Visit Due: In 1 year.
Signature: _________________________
Printed Name: Dr. Emily Carter
Date: 1 November 2024
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