Well Child Report Form

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