Use this chart to keep track of your child's health care visits. Also use this chart to keep track of your child's illnesses (such as ear infections or flu) and injuries (such as broken bones). A record of childhood illnesses and injuries will be useful even when your child is an adult.

Child's Name____________________________________________

Date      Illness/Reason for Visit               Treatment/Medication

_______ _____________________________________ ___________________________ _______ _____________________________________ ___________________________ _______ _____________________________________ ___________________________ _______ _____________________________________ ___________________________ _______ _____________________________________ ___________________________ _______ _____________________________________ ___________________________ _______ _____________________________________ ___________________________ _______ _____________________________________ ___________________________ _______ _____________________________________ ___________________________ _______ _____________________________________ ___________________________ _______ _____________________________________ ___________________________ _______ _____________________________________ ___________________________ _______ _____________________________________ ___________________________ _______ _____________________________________ ___________________________