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Get Pediatric Pt History Form

S the reason for your visit today? PERSONAL HISTORY Breastfeeding? Y/N Born at weeks? Pregnancy or delivery complications? Y/N If yes, what kind of complications? Sleeping concerns? Y/N Hearing concerns? Y/N Vision concerns? Y/N Do you believe your child is developing normally? Y/N Number of sodas a day? Does your child eat a healthy diet?.

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