"Doctors' Pediatric Well Visit Schedule Template"

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DOCTORS’ PEDIATIRC WELL VISIT SCHEDULE
Well Child Visit
Nurse Procedures & Handouts
Tests
Recommended Vaccinations
Prenatal
Welcome kit
N/A
N/A
New baby
New baby handout given
Hepatitis B if not given in hospital
Head circumference (HC)
Weight
Length
2 weeks
HC
Postnatal Screen
None
Weight
Length
6 weeks
6-8 week handout
Hep B # 2 (Hepatitis B)
(must be on or
Vaccine Info Sheets
IPV # 1 (Polio Vaccine)
after 6 weeks
HC
Rota # 1 (Rotavirus Vaccine)
of age)
Weight
Length
9 weeks
3-4 month handout
Postnatal Screen
DTaP #1 (Diphtheria, Tetanus, Pertussis)
Vaccine Info Sheets
Hib #1 (Haemophilus Influenza)
HC
Prevnar #1 (Pneumococcal)
Weight
Length
4 months
Solid food handout
DTaP #2
Rota #2
Hib #2
Vaccine Info Sheets
IPV #2
Prevnar #2
HC
Weight
Length
6 months
5-6 month handout
DTap #3
Hib #3
Prevnar #3
Vaccine Info Sheets
Rota #3
Influenza (if
Choking pamphlet
desired)
HC
Weight
Length
9 months
8-9 month handout
Hemoglobin
Hep B # 3
Vaccine Info Sheets
Lead
Poison control sticker
HC
Weight
Length
12 months
1 year handout
Prevnar # 4
Hib #4
st
(must be on or
Vaccine Info Sheets
Hep A #1 (on or after 1
bday)
st
after 1
bday)
HC
MMR #1 (Measles, Mumps, Rubella)
Weight
Length
15 months
Vaccine Info Sheets
M-Chat
HC
Varivax #1 (Varicella Vaccine)
Weight
Hep A #1 (if not given)
Length
DOCTORS’ PEDIATIRC WELL VISIT SCHEDULE
Well Child Visit
Nurse Procedures & Handouts
Tests
Recommended Vaccinations
Prenatal
Welcome kit
N/A
N/A
New baby
New baby handout given
Hepatitis B if not given in hospital
Head circumference (HC)
Weight
Length
2 weeks
HC
Postnatal Screen
None
Weight
Length
6 weeks
6-8 week handout
Hep B # 2 (Hepatitis B)
(must be on or
Vaccine Info Sheets
IPV # 1 (Polio Vaccine)
after 6 weeks
HC
Rota # 1 (Rotavirus Vaccine)
of age)
Weight
Length
9 weeks
3-4 month handout
Postnatal Screen
DTaP #1 (Diphtheria, Tetanus, Pertussis)
Vaccine Info Sheets
Hib #1 (Haemophilus Influenza)
HC
Prevnar #1 (Pneumococcal)
Weight
Length
4 months
Solid food handout
DTaP #2
Rota #2
Hib #2
Vaccine Info Sheets
IPV #2
Prevnar #2
HC
Weight
Length
6 months
5-6 month handout
DTap #3
Hib #3
Prevnar #3
Vaccine Info Sheets
Rota #3
Influenza (if
Choking pamphlet
desired)
HC
Weight
Length
9 months
8-9 month handout
Hemoglobin
Hep B # 3
Vaccine Info Sheets
Lead
Poison control sticker
HC
Weight
Length
12 months
1 year handout
Prevnar # 4
Hib #4
st
(must be on or
Vaccine Info Sheets
Hep A #1 (on or after 1
bday)
st
after 1
bday)
HC
MMR #1 (Measles, Mumps, Rubella)
Weight
Length
15 months
Vaccine Info Sheets
M-Chat
HC
Varivax #1 (Varicella Vaccine)
Weight
Hep A #1 (if not given)
Length
DOCTORS’ 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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