Well Child Physical Exam Form - Sequatchie Valley Head - sequatchievalleyheadstart 2026

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  1. Click ‘Get Form’ to open the Well Child Physical Exam Form in the editor.
  2. Begin by filling in the child's name and date of birth at the top of the form. This information is crucial for identifying the child.
  3. Next, indicate the payer source by checking one of the options: TN Care, Other Insurance, or Head Start.
  4. In the health history section, provide relevant information about the child's medical background as required.
  5. For healthcare professionals, complete sections on height, weight, blood lead screening, hearing, and other tests. Use 'N' for normal findings and 'A' for abnormal.
  6. Document any abnormal findings in detail and attach any screening tools used if applicable.
  7. Finally, ensure that a health care professional signs and dates the form before submission.

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General: Well appearing, well nourished, in no distress. Oriented x 3, normal mood and affect . Ambulating without difficulty. Skin: Good turgor, no rash, unusual bruising or prominent lesions Hair: Normal texture and distribution.
Examination of the head includes inspection of the face, skin, hair, scalp and skull. Begin by observing facial features, understanding that they may vary by sex and race. Inspect the eyebrows, eyelids, palpebral fissures, nasolabial folds and mouth, noting any asymmetry.
The pediatric physical examination: HEENT. Examination of the head, eyes, ears, nose, and throat (HEENT) in children will be reviewed here.
Inspection (looking at the body) Palpation (feeling the body with fingers or hands) Auscultation (listening to sounds, usually with a stethoscope) Percussion (producing sounds, usually by tapping on specific areas of the body)
Head Start requires a COMPLETE CHDP EQUIVALENT HEALTH EXAM, including BLOOD TESTS FOR LEAD and HEMOGLOBIN. Documentation of ALL screenings is necessary in order to provide prompt assistance to families to best meet the health and developmental needs of the child.

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The physical examination of the face begins when the endobiogenist first views the patient. Forehead: shape, height, length, presence of blemishes. Eyebrows: color compared to hair on head, length (toward the midline and distal ends), density, and distribution of hair.

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