DHS-1639, Well Child Exam Early Childhood: 12 Months
Next Well Check: 15 months of age A standardized developmental screening tool to be administered – see page 2. Page 3 required for Foster Care Children Medical Provider Signature: PAGE 2 – WELL CHILD EXAM – INFANCY: 12 Months – Developmental Surveillance (This page may be used if not utilizing a Validated Developmental Screener) ................
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