Dr. MJ Bazos, MD
6 MONTH Checkup

PATIENT NAME __________________________ DATE ________ DOB _________

Nursing Assessment: Temp _______ DRUG ALLERGIES
Weight _______ Percentile _______ Length _______ Percentile ________
FOC _______ Percentile _______ _______

HISTORY DEVELOPMENT
Interval History: Parental Concerns: ________________________________________
Sits alone briefly Babbles and “razzes”
Rolls from back to front Transfers objects from
Makes consonant sounds one hand to the other
Holds own bottle Turns towards sounds
Sleep Pattern/Position: Sleeping on back? __ Imitates sounds Better control of head & neck
Stools: Consistency/Frequency:______________ Vision: recognizes faces Smiles at mirror

PHYSICAL EXAM
Nutrition:
Breast _____ Bottle ______ (Formula _________) Solids foods - cereals, first foods
System Normal Abnormalities
Adequate Weight Gain ? (15-45gm/day) ___________ General _________________
Fluoride Supplementation? ______Head ____________Fontanelle ______ EENT ______ Neck____ Chest ____________ Lungs _____________ Heart ______ ____________ Abdomen ________________ Genitalia ___________
Back/Spine ___________ Extremities _________ Hips _____________
Skin ______________ Neurologic ______________

Social History: Primary Caregiver ___________Persons present in household? _________
Any changes ?_________________ Immunodeficient household contacts? ____________ Day Care Center ? ________________________

Family Medical History: Family member with TB? __Child at Lead Exposure Risk? ___ ___

ANTICIPATORY GUIDANCE
Get down on floor & check for hazards Crib safety/Sleeping on back No bottle propping
No microwaving bottles No milk or honey No shaking baby
Car Seat / Air bags Rolling off high places Fever
Extra water not necessary Do not leave alone with sibling Immunizations
Water temperature No smoking in home Acetaminophen after shots
Smoke detectors Water safety/Pool safety

ASSESSMENT PLAN
Immunizations: Follow-up visit:
DTP/DTaP