TMPPM 2011 > Children's Services Handbook > Appendix A: THSteps Forms > Child Health Clinical Records

   
 

A.2 Child Health Clinical Records

The use of forms ECH 1-7 is optional. These forms were developed to help providers document all components of the medical checkup. THSteps requires the following forms: Hearing Checklist for Parents, Tuberculosis (TB) Questionnaire, Risk Assessment for Lead Exposure, and the DSHS State Laboratory forms. All of these forms can be downloaded from the THSteps website at www.dshs.state.tx.us/thsteps/forms.shtm. Lead poisoning screening questionnaires can be downloaded from the Texas Childhood Lead Poisoning Prevention Program (TX CLPPP) website at www.dshs.state.tx.us/lead/providers.shtm.

Forms CH-9W through CH-12W may be downloaded from the Centers for Disease Control and Prevention (CDC) website at www.cdc.gov/growthcharts/clinical_charts.htm.

Stock Number
Form

CH-9W

Growth Chart - Infant Girl

CH-10W

Growth Chart - Infant Boy

CH-11W

Growth Chart - Child Girl

CH-12W

Growth Chart - Child Boy

ECH-1

Child Health History

ECH-2

Preventive Health Visit - Birth to 1 Month

ECH-3

Preventive Health Visit - 2-6 Months

ECH-4

Preventive Health Visit - 7-12 Months

ECH-5

Preventive Health Visit - 13 Months to 2 Years

ECH-6

Preventive Health Visit - 3-5 Years

ECH-7

Preventive Health Visit - 6-10 Years

 

Form Pb-110, Risk Assessment for Lead Exposure

 

TB Questionnaire

For forms for documenting medical checkups for adolescents, please refer to sources such as Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents (2nd edition, revised), located at www.brightfutures.org or the Guidelines for Adolescent Preventive Services (GAP) Implementation Materials located at www.ama-assn.org/ama/pub/category/1981.html. For nutritional screening for all ages, refer to Bright Futures.


Texas Medicaid & Healthcare Partnership
CPT only copyright 2010 American Medical Association. All rights reserved.
PreviousNextIndex