CARDIAC AUSCULTATION (if indicated) – congenital heart disease/rheumatic heart disease
IDENTIFIED ISSUES
ACTION
ASSESSMENT OF PARENT-CHILD INTERACTION (if indicated)
IDENTIFIED ISSUES
ACTION
DEVELOPMENTAL ASSESSMENT (age appropriate milestone) where appropriate
IDENTIFIED ISSUES
ACTION
OTHER EXAMINATIONS CONSIDERED NECESSARY BY GP
IDENTIFIED PROBLEMS
ACTION
EXAMINATION
INVESTIGATIONS AS REQUIRED
INVESTIGATION
TESTS DONE
TESTS ORDERED
ARRANGEMENTS(eg referral details)
Haemoglobin testing
Date __/__/____
Audiometry
Date __/__/____
Optometry
Date __/__/____
Other………………………………………………………………………………………………………………………...
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