TMPPM 2008 > Appendices > THSteps Forms > Child Health Clinical Records

   
 

C.2 Child Health Clinical Records

The use of forms ECH 1-7 is optional. These forms were developed to assist providers in documenting all components of the medical check up and can be downloaded from the THSteps website at secure.thstepsproducts.com/forms/ths_forms.htm. Lead poisoning screening questionnaires can be downloaded from the Childhood Lead Poisoning Prevention Program website at www.dshs.state.tx.us/lead/providers.shtm.

Tuberculosis screening questionnaires can be downloaded from the Tuberculosis Elimination Division website, www.dshs.state.tx.us/idcu/disease/tb/forms/default.asp#clinic. These forms are also available within this appendix.

Forms CH-9W through CH-12W are only available by calling THSteps at 1-512-458-7745.

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 check ups for adolescents of all ages, please refer to sources such as Bright Futures: GuideŻlines 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 2007 American Medical Association. All rights reserved.
PreviousNextIndex