Child Health Guide
Important Information
Using these records to keep track of your child's health care will give you the
information you need to stay on top of a constantly changing situation. Make as many
copies as you need for each child. There are records here for immunizations
(shots), growth, various tests (such
as blood pressure, hearing, and dental), and visits and illnesses.
Child's Name:___________________________________________________________
Date of Birth:__________________________________________________________
Parent/Guardian Name(s): _______________________________________________
Home Telephone: ________________________________________________________
Work Telephone(s): _____________________________________________________
Address: _______________________________________________________________
________________________________________________________________________
Important Health Problems/Allergies: ___________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Health Care Provider Name(s) and Phone Number(s) _______________________
________________________________________________________________________
________________________________________________________________________
Health Insurance Number(s): ___________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Poison Control Center Phone Number: ____________________________________
Return to Child Health Guide
|
