WCMC Department of Dermatology- Pediatric Patient Follow- up Intake Form 2026

1. Click ‘Get Form’ to open the WCMC Department of Dermatology- Pediatric Patient Follow-up Intake Form in our editor.
2. Begin by entering the patient's name and date at the top of the form. This information is crucial for identifying your child’s records.
3. Fill in the pediatrician's name and contact details. This helps ensure that all relevant medical history is accessible during the visit.
4. Specify the reason for today's visit by detailing any affected areas of the body. Use clear, concise language to describe your child's concerns.
5. Complete the section regarding your child's current school grade and any pets at home, as this can provide context for their health.
6. Indicate whether your child's immunizations are up to date and note any outstanding vaccinations if applicable.
7. If there have been any major illnesses or hospital visits since the last appointment, check 'Yes' and specify any issues from the provided list.
8. Document any medication or latex allergies, along with a list of current medications, including over-the-counter drugs and herbal treatments.
9. Finally, review family history changes, complete the Wong-Baker pain scale, and note any additional issues you wish to discuss during today’s visit.

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