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 and Self-help | Motor Development |
| Does your child
Engage in parallel play (play alongside others but not with them) Use 50 words? Combines 2 words in a phrase? (more milk?) Identify at least 5 body parts? (including nose, stomach, foot, arm) Have speech that is at least 50% understandable to strangers? (often parents will “interpret” the child’s words to strangers) |
Gross Motor
Run? Kick a ball? Jump off the ground with both feet? (fun activity to do during the PE) Fine Motor Stack objects? Draw a line? ( have them draw a picture while you talk to their parent) |
Review of Systems
Do you have any concerns about your child’s
Development
Skin
HEENT
Breathing
Stomach
