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Get Child Health Record Form 2019-2024

Rvations): SECTIONS BELOW TO BE COMPLETED BY PHYSICIAN 2. SCREENING TESTS. (*) REQUIRED by Head Start. Enter dates if done previously. TEST DATE RESULTS a. PRESENT AGE* Yrs. Mos. j. VISION (Type of test): * DATE: b. HEIGHT (no shoes, to nearest 1/8 in.)* ACUITY, R/L: c. WEIGHT (light clothing to nearest lb.)* STRABISMUS: d. BMI COMMENTS: k. HEARING (Type of test): e. BLOOD PRESSURE* * DATE: f. TEMPERATURE RESULTS, R/L: COMMENTS: g. RESPIRATION TEST DATE RESULTS l. OTHER TESTS (if indicated) (.

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