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Rourke Baby Record - 3 years

Gestational Age: 
Birth Length:  cm
Birth Weight:  g
Birth Head Circumference: cm

Past problems/Risk factors :
Family history :

GROWTH (Correct age until 24-36 months if < 37 weeks gestation)
Height :
Weight :
Head circumference (if prior abnormal) :
BMI :

PARENT/CAREGIVER CONCERNS :


NUTRITION







EDUCATION AND ADVICE (repeat discussion of items is based on perceived risk or need)
Injury Prevention








Behaviour







Family







Environmental Health




Others





DEVELOPMENT










PHYSICAL EXAMINATION








PROBLEMS AND PLANS/CURRENT AND NEW REFERRALS
(e.g. medical specialist, dietitian, speech, audiology, PT, OT, eyes, dental, social determinants resources) :


INVESTIGATIONS/SCREENING AND IMMUNIZATION (discuss immunization benefits and pain reduction strategies)





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