Doctors' Pediatirc Well Visit Schedule Template Page 2
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1
2DOCTORS’ PEDIATIRC WELL VISIT SCHEDULE
18 months
18 month handout
M-Chat
DTaP #4
IPV #3 (if not
Vaccine Info Sheets
already given)
HC
Weight
Length
2 years old
2 year old handout
Hemoglobin
Hep A # 2 (if not given)
Vaccine Info Sheets
Lead
MMRV (Second dose of MMR and
HC
M-Chat
Varivax)
Weight
Length
2 ½ (30
Height – standing
M-Chat
None
months)
Weight
3 years old
3 year old handout
Catch up on vaccines if needed
Weight
Height
Blood pressure
4 years old
4 year old handout
DTaP #5
(must be on or
Vaccine Info Sheets
IPV #4
th
after 4
bday)
Weight
Height
Blood pressure in arm/ leg
Pulse
Hearing/ vision
5 years old
5 year old handout
Hemoglobin
Weight
Urinalysis
Height
Blood pressure
Pulse
Hearing/ vision
6 -10 years old
Weight
Pedi Screen
Catch up on vaccines if needed
Height
Blood pressure
Pulse
Hearing/ vision
11 years old
Vaccine Info Sheets
Hemoglobin (for all
Tdap (Tetanus, Diphtheria, and Pertussis)
Weight
girls with menses)
Menactra (Meningitis)
Height
Hemoglobin and
th
Blood pressure
urinalysis (for 6
th
Pulse
going into 7
grade)
Hearing/ vision
Pedi Screen
12- college age
Teen handout
Hemoglobin (for all
Vaccine Info Sheets
girls with menses)
HPV vaccine (Human Papillomavirus)
Testicular self-exam
Hemoglobin and
Catch up on vaccines if needed
th
th
handout (boys ages 14+)
urinalysis (for 9
Menactra Booster (on or after 16
bday)
th
Breast self-exam handout
into 10
grade)
(girls age 14+)
Pedi Screen (12 year
Weight
olds)
Height
Teen Screen (13 –
Blood pressure
17 year olds)
Pulse
Hearing/ vision
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