Well Child Exam Infancy: 6 Months - Michigan
Next Well Check: 9 months of age Developmental Surveillance on Page 2. Page 3 required for Foster Care Children Medical Provider Signature: PAGE 2 – WELL CHILD EXAM – INFANCY: 6 Months – Developmental Surveillance (This page may be used if not utilizing a Validated Developmental Screener) Date Child’s Name DOB ................
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