8-11 YEARS SUBJECTIVE: _ here for well child check. No parental or patient concerns at this time.
Here with parent: _ REVIEW OF SYSTEMS: - Diet: No concerns. - Fast food, soda, juice intake: _ - Calcium intake: _ - Dental: + brushes teeth. Sees the dentist regularly. - Sleep concerns (duration, snoring, bedtime): None. - Elimination concerns (including menses in females): _ PM/SH: Normal pregnancy and delivery. No surgeries, hospitalizations, or serious illnesses to date. DEVELOPMENT: - In _ grade. School is going well. No parental or teacher concerns about behavior. - Friends/hobbies (i.e. after school activities): _ - Physical activity (and safety): _ - Screen time: _ SOCIAL: - Noteworthy social stressors: _ - No smokers in the home. - No TB or lead risk factors. IMMUNIZATIONS: - Up to date. OBJECTIVE: - VITALS: _ - WEIGHT: BMI _ - GEN: Normal general appearance. NAD. - HEAD: NCAT. - EYES: PERRL, red reflex present bilaterally. Light reflex symmetric. EOMI. - ENMT: TMs and nares normal. MMM. Normal gums, mucosa, palate, OP. Good dentition. - NECK: Supple, with no masses. - CV: RRR, no m/r/g. - LUNGS: CTAB, no w/r/c. - ABD: Soft, NT/ND, NBS, no masses or organomegaly. - GU: Normal genitalia, Tanner stage _ - SKIN: WWP. No skin rashes or abnormal lesions. - MSK: No deformities or signs of scoliosis. Normal gait. No clubbing, cyanosis, or edema. - NEURO: Normal muscle strength and tone. No focal deficits. LABS/STUDIES: - Urine dip normal. - Hearing screen normal. - Snellen testing: _ ASSESSMENT/PLAN: * Healthy _ yo child - CBC ordered. No indication for DM screening. - Check lipid panel between 9-11 yo, repeat 18-21 yo. - Screen for depression _ >12 yo. - Follow in one year, or sooner PRN. - ER/return precautions discussed. * Vaccines today: - Influenza, HPV (0, 1-2, and 6 months, starting at age 9), Tdap (11-12), Meningococcal (11-12) * Anticipatory guidance (discussed or covered in a handout given to the family) - Puberty - Peer pressure, bullying, communication with teachers, violence prevention - Seat belts, helmets and safety gear, sunscreen - Internet safety, limiting screen time - Appropriate discipline for age - Healthy food, exercise, good dental hygiene - Eliminating guns from the home, or locking bullets separately - Hazards of second hand smoke