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Get Kan Be Healthy Form 2007-2024

% BMI BMI ≥ 85%: recommend appropriate nutrition input and physical activity. th% Male Female Update Growth Chart (required at each screen) BENEFICIARY & FAMILY HISTORY Refer to completed history form in chart. Present Concern: No changes in medical Hx unless indicated. Previous Hx reviewed from________________ visit. Patient currently in Foster care, no previous hx available. Serious Illness/Accidents: Medications: No Yes (date & type) (including Hospital or ER visits) Allergies (foo.

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