Contents
Interval History
What happened since the last health supervision visit? Be sure to include any parent concerns.
Examples
- “What are you most proud of since our last visit?”
- “What do you like most about your son/daughter?”
- “What questions or concerns do you have about your child?”
Ask about past history. Any visits to the emergency department or urgent care? Any changes in the health of anyone in the family?
Development
Any specific concerns?
| Language Development | Motor Development |
|
Does your child look for hidden objects? Imitate activities? Imitate vocalizations/sounds? Speak 1-2 words (Mama or Dada specifically?) Follow simple directions? |
Gross Motor Does he/she take the first steps? Stand alone? Fine Motor Pick up an object with a 2-pincer grasp? Pick up food and eat it? |
Developmental Handout for 12-24 months
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Open in new tab Review of Systems
Do you have any concerns about your child’s:
- Development
- Skin
- Head, eyes, ears, nose, and throat (HEENT)
- Breathing
- Stomach
- Genitals / Rectum
