Bayan Taxonomy Explorer

جواز صحة الطفل

ia_gov_sa · · processed · 96 chunks

date_gregorian=2025-10-23 date_hijri=1447-05-01 document_type=form entity=language:ar entity=format:application/pdf language=mixed taxonomy_l1=economy_finance taxonomy_l2=insurance validity=valid validity_confidence=0.6

X احمد الجدي Ministry of Health VISION ال،ر 2.30 المواكه العربيه السعوديه KINDOM OF SAUDI ARABIA الجواز الصحي للطفل Child Health Passport الطبيه الثانيه ٢٠٠٠ / ١٤٤ PHC/Hospital : .... اسم المستشفي/المركز الصحي: Region : .... المنطقه: Health Passport Recipe Date : .... /.... /.... /.... : تاريخ استلام الجواز: البيانات الاساسيه للطفل : Child's Name: .... Nationality : .... Place of Birth : .... Date of Birth : .... تاريخ الولااده: File No. : .... رقم الملف الصحي Unique File No. : .... رقم الملف الفردي: HESN Registration No. : .... رقم التسجيل في صن: Mother's Name : .... اسم الام: Mobile No. : .... رقم الجوال Address : ....عنوان: Other Data : بيانات اخري : الفهرس • الجواز الصحي للطفل • مراحل زيارات متابعه الطفل الرييسيه • المرحله الاولي: التسجيل واخذ التاريخ الطبي والعايلي وتاريخ الحمل والولاده وعمل الفحص السيربي عند الولاده • التاريخ العالسي والولاده • تاريخ الولاده والفحص السيربي بعد الولاده • التاريخ الطبي للقطن • المرحله الثانيه: من (1-4) اسابيع بعد الولاده • الزياره الاولي بعد الولاده في الاسبوع الاول • الزياره الثانيه: بعد الولاده في الاسبوع الرابع • المرحله الثالثه: من سن الشهرين (0) سنوات • الزياره الاولي عند سن الشهرين • الزياره الثانيه عند سن (4) اشهر • الزياره الثالثه عند سن (6) اشهر • العنايه بصحه فم واسنان الرضيع • الزياره الرابعه عند سن (9) اشهر • الزياره الخامسه عند سن (12) شهر • الزياره السادسه عند سن (18) شهر • الزياره السابعه عند سن السنتين • الزياره الثامنه عند سن ثلات سنوات 39 • الزياره العاشره عند سن اربع سنوات • منحنيات النمو للطفل ومنحنيات ضغط الدم • بعض الملامح الاولي لنمو وتطور الطفل • اختبار دفر المختصر المعدل • عوامل الخطوره للاطفال المعرضين للخطر (المجموعه) • عوامل الخطوره للاطفال المعرضين للخطر (المجموعه ب) • عوامل الخطوره للاطفال المعرضين للخطر (المجموعه ج) • تدوير حالات المعرضين للخطر من الاطفال اقل من خمس سنوات • نماذج الاحاله والتغذيه الراجعه • جدول ملخص الاحالات والتغذيه الراجعه • وصايا قيمه لكل ام الجواز الصحي للطفل : هو وثيقه تخص كل طفل منذ ولادته وحتي بلوغه سن خمس سنوات. استخدامات الجواز وسيله تثقيف صحي اماه نظام الاحاله بين مستويات الخدمه الصحيه سجل متنقل بين المستفيد ومقدم الخدمه الصحيه الجوز ال صحي لل طفل Child's Health Passport نحو صحه افصل للاطفال مراحل زيارات متابعه الطفل الرييسيه عند الولاده ويتم فيها الفحص السريري والاجراءات الاساسيه مثل الكشف المبكر عن الاعاقه السمعيه وامراض القلب الخلقيه بالاضافه للفحوصات المخبريه لبعض Amarاض الاستقلابيه. المرحله الاولي هي التي تتم فيها متابعه المولود وتكون اثناء فتره النفاس حيث تضرام مولدوها معها للمتابعه. وتتضمن زيارتين اساسيتين، الاولي عند الاسبوع الاول من الولاده وتتم في عياده الامومه والزياره الثانيه في نهايه الاسبوع الرابع من الولاده وتكون في عياده الطفل السليم. المرحله الثانيه هي التي تتم فيها متابعه الطفل منذ سن الشهرين وحتي بلوغه سن خمس سنوات وذلك بعياده الطفل السليم، وتحتوي هذه المرحله علي عشر زيارات محدده التوقيت، يتم فيها قياس مؤشرات نمو الطفل وتطوره وفحصه اكلينيكيا، بالاضافه لاعطايه التطعيمات الاساسيه. المرحله الثالثه الاجراءات الاساسيه لمتابعه الطفل (المرحله الاولي: التسجيل واخذ التاريخ الطبي والعايلي) وتاريخ العمل والولاده وعمل الفحص السريري عند الواده (يتم تعبيه البيانات من الجواز الصحي للام) <table><tr><td colspan="4">Family and Obstetric History</td></tr><tr><td colspan="2">Obstetric History</td><td>No</td><td>Yes</td></tr><tr><td>Drugs</td><td>If yes specify......</td><td></td><td></td></tr><tr><td>Rays</td><td></td><td></td><td></td></tr><tr><td>Birth weight of last baby < 2500 g</td><td></td><td></td><td></td></tr><tr><td>Birth weight of last baby > 4500 g</td><td></td><td></td><td></td></tr><tr><td>Last pregnancy hospital admission for hypertension or preeclampsia / eclampsia</td><td></td><td></td><td></td></tr><tr><td>General Medical History</td><td></td><td>NO</td><td>Yes</td></tr><tr><td>Diabetes mellitus</td><td></td><td></td><td></td></tr><tr><td>Hypertension</td><td></td><td></td><td></td></tr><tr><td>Cardiac disease</td><td></td><td></td><td></td></tr><tr><td>T.B.</td><td></td><td></td><td></td></tr><tr><td>Renal disease</td><td></td><td></td><td></td></tr><tr><td>Congenital abnormalities</td><td></td><td></td><td></td></tr><tr><td>Genetic Disorders</td><td></td><td></td><td></td></tr><tr><td>Metabolic Diseases</td><td></td><td></td><td></td></tr><tr><td colspan="4">other diseases</td></tr><tr><td>Psychological History</td><td></td><td>No</td><td>Yes</td></tr><tr><td>Depression</td><td></td><td></td><td></td></tr><tr><td>Anxiety</td><td></td><td></td><td></td></tr><tr><td colspan="4">Other</td></tr><tr><td colspan="4">Social History</td></tr><tr><td colspan="4">Mother's age:</td></tr><tr><td colspan="4">Education level:</td></tr><tr><td colspan="4">Occupation:</td></tr><tr><td colspan="4">Child Birth Order:1st ---- 2nd ---- 3rd ---- 4th ---- 5th ---- Other----</td></tr><tr><td colspan="4">Number of family members in household:</td></tr><tr><td colspan="4">Consanguinity: No ( ) Yes ( )</td></tr><tr><td colspan="4">Smoking: No ( ) Yes ( ) cigarette/day ......</td></tr><tr><td colspan="4">Substance abuse No ( ) Yes ( )</td></tr></table> <table><tr><td colspan="5">Child Birth's History</td></tr><tr><td>Date of Birth:</td><td colspan="4"></td></tr><tr><td>Place of Birth</td><td colspan="4"></td></tr><tr><td>Supervision</td><td colspan="4">Doctor ( ) midwife ( ) Non ( )</td></tr><tr><td>Admission on to NICU</td><td colspan="4">Yes ( ) NO ( )If yes what is the reason?</td></tr><tr><td>Newborn Growth</td><td colspan="4">Term ( ) Preterm ( ) post- dated ( ) others ( )</td></tr><tr><td>Measurements at Birth</td><td colspan="4">Weight ( ) kg Length ( ) cm Head circumference ( ) cm</td></tr><tr><td>Pregnancy History</td><td colspan="4">Single( ) Twin( ) Triple( ) other( )</td></tr><tr><td>Delivery History</td><td colspan="4">Normal delivery ( ) Cesarean( ) Other ( )</td></tr><tr><td rowspan="3">Vaccination history</td><td colspan="4">Name of Vaccine</td></tr><tr><td colspan="4">Date of Vaccine</td></tr><tr><td colspan="4">Reason for Vaccine</td></tr><tr><td>Blood Group & Rhesus factor(RH)</td><td colspan="4"></td></tr><tr><td>Screening Tests</td><td colspan="2">Test done</td><td colspan="2">Test result</td></tr><tr><td>Newborn screening for Metabolic disorders and Hereditary diseases</td><td>Yes</td><td>No</td><td>Normal</td><td>Abnormal</td></tr><tr><td>Newborn Hearing Screening test</td><td></td><td></td><td></td><td></td></tr><tr><td>Newborn Congenital Heart diseases Screening test</td><td></td><td></td><td></td><td></td></tr></table> Birth's Clinical Examination <table><tr><td>Clinical Examination</td><td>Normal</td><td>Abnormal</td><td>Comments</td></tr><tr><td>Cyanosis</td><td></td><td></td><td></td></tr><tr><td>Dyspnea</td><td></td><td></td><td></td></tr><tr><td>Jaundice</td><td></td><td></td><td></td></tr><tr><td>Skin</td><td></td><td></td><td></td></tr><tr><td>Reflexes</td><td></td><td></td><td></td></tr><tr><td>Red Reflexe</td><td></td><td></td><td></td></tr><tr><td>Cataracts</td><td></td><td></td><td></td></tr><tr><td>Dimorphism</td><td></td><td></td><td></td></tr><tr><td>Cleft palate/lip</td><td></td><td></td><td></td></tr><tr><td>Muscle tone</td><td></td><td></td><td></td></tr><tr><td>Murmur</td><td></td><td></td><td></td></tr><tr><td>Hepatomegaly</td><td></td><td></td><td></td></tr><tr><td>Splenomegaly</td><td></td><td></td><td></td></tr><tr><td>Abdominal masses</td><td></td><td></td><td></td></tr><tr><td>Umbilicus</td><td></td><td></td><td></td></tr><tr><td>External genital organs</td><td></td><td></td><td></td></tr><tr><td>Anal orifice</td><td></td><td></td><td></td></tr><tr><td>Back</td><td></td><td></td><td></td></tr><tr><td>Limbs</td><td></td><td></td><td></td></tr><tr><td>Developmental hip Dysplasia</td><td></td><td></td><td></td></tr><tr><td colspan="4">Physician's name ...... Signature ...... Date ......</td></tr></table> <table><tr><td colspan="4">Child Medical History</td></tr><tr><td>Disease</td><td>Yes</td><td>No</td><td>Date diagnosed & Rx</td></tr><tr><td>Diabetes Mellitus (DM)</td><td></td><td></td><td></td></tr><tr><td>Bronchial Asthma</td><td></td><td></td><td></td></tr><tr><td>Allergy (specify)</td><td></td><td></td><td></td></tr><tr><td>Trauma(specify)</td><td></td><td></td><td></td></tr><tr><td colspan="4">Health's Problems/ Injuries</td></tr><tr><td>Disease</td><td>Yes</td><td>No</td><td>Date diagnosed & Rx</td></tr><tr><td>Cardiovascular System</td><td></td><td></td><td></td></tr><tr><td>Respiratory System</td><td></td><td></td><td></td></tr><tr><td>Nervous System</td><td></td><td></td><td></td></tr><tr><td>Musculoskeletal System</td><td></td><td></td><td></td></tr><tr><td>Eyes</td><td></td><td></td><td></td></tr><tr><td>Ears</td><td></td><td></td><td></td></tr><tr><td>Chronic Diseases</td><td></td><td></td><td></td></tr><tr><td>Metabolic Diseases</td><td></td><td></td><td></td></tr><tr><td>Genetic Disorders</td><td></td><td></td><td></td></tr><tr><td>Congenital Anomalies</td><td></td><td></td><td></td></tr><tr><td>Other Diseases</td><td></td><td></td><td></td></tr><tr><td colspan="4">Physician's name ...... Signature ...... Date ......</td></tr></table> الرضاعه الطبيعيه افضل غداء متكامل للملود خلال السنه اشهر الاولي من عمره فاحرصي عليها (ب) المرحله الثانيه من (4-1) اسابيع بعد الولاده: <table><tr><td colspan="2">First Postnatal Visit at 1st Week(الزياره تتم في عياده الاومنه و تعبيه البيانات تتم في عياده الطفل السليم)</td></tr><tr><td>Date of visit:</td><td>Newborn age ( ) days</td></tr><tr><td>Cause of visit</td><td>Routine ( ) Complaint ( )What is the complaint?</td></tr><tr><td>Type of feeding</td><td>Exclusive breast feeding ( )Only Milk formula ( ) Mixed feeding ( )</td></tr><tr><td>Any significant History</td><td></td></tr><tr><td>Vaccination at birth</td><td>Hep B ( )</td></tr><tr><td>Temperature</td><td></td></tr><tr><td>Weight ( ) kg Length ( ) cm Head circumference ( ) cm</td><td></td></tr><tr><td colspan="2">Clinical Examination</td></tr><tr><td colspan="2">Fontanels</td></tr><tr><td>Jaundice</td><td></td></tr><tr><td>Peripheral or central cyanosis</td><td></td></tr><tr><td>Dyspnea</td><td></td></tr><tr><td>Cataracts</td><td></td></tr><tr><td>Dimorphism</td><td></td></tr><tr><td>Cleft/Lip palate</td><td></td></tr><tr><td>Muscle tone</td><td></td></tr><tr><td>Neonatal reflexes / Red reflex</td><td></td></tr><tr><td>Murmur</td><td></td></tr><tr><td>Hepatomegaly</td><td></td></tr><tr><td>Splenomegaly</td><td></td></tr><tr><td>Abdominal masses</td><td></td></tr><tr><td>Umbilicus</td><td></td></tr><tr><td>External genital organs</td><td></td></tr><tr><td>Limbs</td><td></td></tr><tr><td>Hips</td><td></td></tr><tr><td>Anal Orifice</td><td></td></tr><tr><td>Special investigations If needed & Results</td><td></td></tr><tr><td>Results of National Program of Newborn Screening</td><td></td></tr><tr><td>Treatment if needed</td><td></td></tr><tr><td colspan="2">Physician's name: ...... signature: ...... Date: ......</td></tr></table> <table><tr><td colspan="2">Second Postnatal Visit at 4thWeek(الزياره و tangible البيانات تتم في عياده الطفل السليم)</td></tr><tr><td>Date of visit:</td><td>Newborn age ( ) days</td></tr><tr><td>Cause of visit</td><td>Routine ( )Complaint ( )What is the complaint?</td></tr><tr><td>Type of feeding</td><td>Exclusive breast feeding ( )Only Milk formula ( )Mixed feeding ( )</td></tr><tr><td colspan="2">Past History</td></tr><tr><td colspan="2">Vaccination at birth</td></tr><tr><td>Temperature</td><td></td></tr><tr><td>Weight</td><td>( ) kg</td></tr><tr><td>Length</td><td>( ) cm</td></tr><tr><td>Head circumference</td><td>( ) cm</td></tr><tr><td colspan="2">Clinical Examination</td></tr><tr><td colspan="2">Fontanels</td></tr><tr><td colspan="2">Red Reflex</td></tr><tr><td>Cardiovascular system</td><td></td></tr><tr><td>Respiratory system</td><td></td></tr><tr><td>Abdomen</td><td></td></tr><tr><td>Local examination of umbilical cord stump</td><td></td></tr><tr><td>Developmental hip Dysplasia</td><td></td></tr><tr><td>Special investigations If needed & Results</td><td></td></tr><tr><td>Treatment if needed</td><td></td></tr><tr><td colspan="2">Physician's name: signature: Date:</td></tr></table> (ج) المرحله الثالثه من سن شهرين (5) سنوات: اجراءات الزيارات الاساسيه لمتابعه الطفل بعياده الطفل السليم بمراكز الرعايه الصحيه الاوليه <table><tr><td colspan="2">First visit at age 2 months</td></tr><tr><td>Actual child age:</td><td>Visit's date:</td></tr><tr><td>Feeding History</td><td>Exclusive breast feeding ( )Mixed feeding ( )Only milk formula ( )</td></tr><tr><td>VaccinationUpdate</td><td>Yes ( ) No ( ), Why: ......Reference number of HESN: ......</td></tr><tr><td colspan="2">Nurse's assessment</td></tr><tr><td>Weight</td><td>( ) kg</td></tr><tr><td>Length</td><td>( ) cm</td></tr><tr><td>Head Circumference</td><td>( ) cm</td></tr><tr><td>Temp</td><td></td></tr><tr><td colspan="2">(Measurements should be plotted on charts in the annexes of the passport)</td></tr><tr><td>Growth Follow up</td><td>Normal ( ) Abnormal ( ), Mention ......If abnormal, what is the action taken? Referral ( ) Follow up ( )</td></tr><tr><td>Child Development Assessment</td><td>Normal ( ) Abnormal ( ), Mention......(Data Should be registered in the Denver Form page 68)If Abnormal, What is the action taken? Referral ( ) Follow Up ( )RED FLAGS AT 2 MONTHS OF AGE:☐ Does not respond to loud sounds☐ Does not watch things as they move☐ Does not smile at people☐ Does not bring hands to mouth☐ Cannot hold head up when pushing up when on tummy</td></tr><tr><td colspan="2">Doctor's assessment</td></tr><tr><td>Vision</td><td>Squint: Present ( ) Absent ( )Eye Reflex (Corneal): Normal ( ) Abnormal ( )Eye Reflex (Red): Normal ( ) Abnormal ( )Abnormality detected: ......If Abnormal, What is the action taken: Referral ( ) Follow Up ( )RED FLAGS BIRTH ONWARDS:☐ Family History of retinoblastoma (at any age)☐ Parental concern regarding white pupil</td></tr></table> <table><tr><td>Hearing</td><td>Normal ( ) Abnormal ( )If Abnormal, What is the action taken: Referral ( ) Follow Up ( )RED FLAGS:Family history of deafnessParental concern regarding ability to respond to soundsHistory suggestive of neonatal hypoxemiaHistory of neonatal hyperbilirubinemia</td></tr><tr><td colspan="2">Physical Assessment</td></tr><tr><td>General Appearance:</td><td>( ) Normal ( ) Abnormal (specify):......</td></tr><tr><td>Head /Fontanels:</td><td>( ) Normal ( ) Abnormal, Specify......</td></tr><tr><td>EYE:</td><td>( ) Normal ( ) AbnormalAbnormal red reflex □ Nystagmus □ Persistent strabismusCorneal opacities □ Cataracts □ tearing or discharge</td></tr><tr><td>EARS:</td><td>( ) Normal ( ) Abnormal, Specify ...... ( ) Abnormal ABR</td></tr><tr><td>NOSE:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>MOUTH/THROAT:</td><td>( ) Normal ( ) Abnormal, Specify ...... ( ) Others ......</td></tr><tr><td>NECK:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>BREAST:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>ABDOMEN:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>C.V.S: Sounds:</td><td>S1...... S2...... added sounds: □ NOT □ YES,......</td></tr><tr><td>RESP. SYSTEM</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>HERNIA:</td><td>( ) NO ( ) YES</td></tr><tr><td>GENITALIA:</td><td>( ) Normal ( ) Abnormal: ......</td></tr><tr><td>SKIN:</td><td>Colour: □ Normal □ Abnormal, Pigmentation: □ NO □ YES___Rash: □ NO □ YES ......</td></tr><tr><td>MUSCULOSKEL- ETAL:</td><td>□ Normal □ Abnormal ......Hip: □ Normal □ Dislocation BACK: □ Normal □ Abnormal(●Spina bifida ●Scoliosis)</td></tr></table> <table><tr><td>NEUROLOGICAL SYSTEM:</td><td>1. Tone: □ Normal □ Hypotonia □ Hypertonia2. Power: □ Normal □ Abnormal, Specify ......3. Reflex: □ Normal □ Hyperoflexia □ Hyperreflexia4. Symmetry of Movement: □ NO □ YES5. Primitive Reflexes:I. The Moro Reflex:□ Present:(□ Symmetrical □ Asymmetrical) □ AbsentII. The Palmar Reflex: □ Present □ AbsentIII. The Rooting Reflex: □ Present □ AbsentIV. Spinal Galant: □ Present □ Absent</td></tr><tr><td colspan="2">Results of Physical Assessment Normal ( ) Abnormal ( ), Mention: ......</td></tr><tr><td colspan="2">If Abnormal, What is the action taken: Referral ( ) Follow Up ( )</td></tr><tr><td colspan="2">Exposure to Risk Factors</td></tr><tr><td>RISK ASSESSMENT:</td><td>( ) No risk ......( ) with risk □ A: ...... □ B:...... □ C:......Assessment of the risk detected: ......(For the Categories of the Children Exposed to risk please refer to pages 69-74)</td></tr><tr><td>Laboratory Investigations (If found)</td><td></td></tr><tr><td>Treatment (If found)</td><td></td></tr><tr><td>Overall Findings/ Plan</td><td>( ) Normal( ) Abnormal findings: ......PLAN:□ Follow-up□ Medication ......□ Health Education: ......□ Referral: □ YES □ NO</td></tr><tr><td>Next visit's date:</td><td></td></tr><tr><td colspan="2">Physician's name: ...... signature: ...... Date: ......</td></tr></table> تطعيم الطفل بلقاحات التطعيم الاساسيه (٢٤) حسب جدول التطعيم من عمر يوم وحتي شهر، تحميه من الاصابه بامراض الطفوله المعديه وتقوي مناعته، يتم ابطاء لقاحات التطعيم عن طريق: الحقن الفم <table><tr><td colspan="2">Second visit at age 4 months</td></tr><tr><td>Actual child age:</td><td>Visit's date:</td></tr><tr><td>Feeding History</td><td>Exclusive breast feeding ( )Mixed feeding ( )Only milk formula ( )</td></tr><tr><td>Vaccination Update</td><td>Yes ( ) No ( ), Why: ......Reference number of HESN: ......</td></tr><tr><td colspan="2">Nurse's assessment</td></tr><tr><td>Weight</td><td>( ) kg</td></tr><tr><td>Length</td><td>( ) cm</td></tr><tr><td>Head Circumference</td><td>( ) cm</td></tr><tr><td>Temp</td><td></td></tr><tr><td colspan="2">(Measurements should be plotted on charts in the annexes of the passport)</td></tr><tr><td>Growth Follow up</td><td>Normal ( ) Abnormal ( ), Mention ......If abnormal, what is the action taken? Referral ( ) Follow up ( )</td></tr><tr><td>Child Development Assessment</td><td>Normal ( ) Abnormal ( ), Mention......(Data Should be registered in the Denver Form page 68)If Abnormal, What is the action taken? Referral ( ) Follow Up ( )RED FLAGS:☐ Does not watch things as they move☐ Cannot hold head steady☐ Does not smile at people☐ Does not coo or make sounds☐ Does not bring hands to mouth☐ Does not push down with legs when feet are placed on a hard surface</td></tr><tr><td colspan="2">Doctor's assessment</td></tr><tr><td>Vision</td><td>Squint: Present ( ) Absent ( )Eye Reflex (Corneal): Normal ( ) Abnormal ( )Eye Reflex (Red): Normal ( ) Abnormal ( )Abnormality detected: ......If Abnormal, What is the action taken: Referral ( ) Follow Up ( )RED FLAGS:☐ Family History of retinoblastoma (at any age)☐ Parental concern regarding white pupil</td></tr></table> <table><tr><td>Hearing</td><td>Normal( ) Abnormal( ), Specify ......If Abnormal, What is the action taken: Referral( ) Follow Up( ) RED FLAGS:☐ Family history of deafness☐ Parental concern regarding ability to respond to sounds☐ History suggestive of neonatal hypoxemia☐ History of neonatal hyperbilirubinemia</td></tr><tr><td colspan="2">Physical Assessment</td></tr><tr><td>General Appearance:</td><td>( ) Normal ( ) Abnormal (specify): ......</td></tr><tr><td>Head /Fontanels:</td><td>( ) Normal ( ) Not: ......</td></tr><tr><td>EYE:</td><td>( ) Normal ( ) Abnormal☐ Abnormal red reflex ☐ Nystagmus ☐ Persistent strabismus☐ Corneal opacities ☐ Cataracts ☐ tearing or discharge</td></tr><tr><td>EARS:</td><td>( ) Normal ( ) Abnormal, Specify ...... ( ) Abnormal ABR</td></tr><tr><td>NOSE:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>MOUTH/THROAT:</td><td>( ) Normal ( ) Abnormal, Specify ...... ( ) Others ......</td></tr><tr><td>NECK:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>BREAST:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>ABDOMEN:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>C.V.S: Sounds:</td><td>S1...... S2...... added sounds: ☐ NOT ☐ YES,......</td></tr><tr><td>RESP. SYSTEM</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>HERNIA:</td><td>( ) NO ( ) YES</td></tr><tr><td>GENITALIA:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>SKIN:</td><td>Colour: ☐ Normal ☐ Abnormal, Pigmentation: ☐ NO ☐ YES___Rash: ☐ NO ☐ YES ......</td></tr><tr><td>MUSCULOSKEL-ETAL:</td><td>☐ Normal ☐ Abnormal ...... Hip: ☐ Normal ☐ DislocationBACK: ☐ Normal ☐ Abnormal (●Spina bifida ●Scoliosis)</td></tr><tr><td>NEUROLOGICAL SYSTEM:</td><td>1. Tone: ☐ Normal ☐ Hypotonia ☐ Hypertonia2. Power: ☐ Normal ☐ Abnormal, Specify ......3. Reflex: ☐ Normal ☐ Hyporeflexia ☐ Hyperreflexia4. Symmetry of Movement: ☐ NO ☐ YES5. Primitive Reflexes:I. The Moro Reflex :☐ Present:( ☐ Symmetrical ☐ Asymmetrical) ☐ AbsentII. The Palmar Reflex : ☐ Present ☐ AbsentIII. The Rooting Reflex : ☐ Present ☐ AbsentIV. Spinal Galant : ☐ Present ☐ Absent</td></tr></table> <table><tr><td colspan="2">Results of Physical Assessment Normal ( ) Abnormal ( ), Mention: ......If Abnormal, What is the action taken: Referral ( ) Follow Up ( )</td></tr><tr><td colspan="2">Exposure to Risk Factors</td></tr><tr><td>RISK ASSESSMENT:</td><td>( ) No risk ......( ) with risk ☐ A: ...... ☐ B: ...... ☐ C: ......Assessment of the risk detected: ......(For the Categories of the Children Exposed to risk please refer to pages 69-74)</td></tr><tr><td>Laboratory Investigations (If found)</td><td></td></tr><tr><td>Treatment (If found)</td><td></td></tr><tr><td>Overall Findings/ Plan</td><td>( ) Normal( ) Abnormal findings: ......PLAN:☐ Follow-up☐ Medication ......☐ Health Education: ......☐ Referral: ☐ YES ☐ NO</td></tr><tr><td>Next visit's date:</td><td></td></tr><tr><td colspan="2">Physician's name: ...... signature: ...... Date: ......</td></tr></table> लिम्प व्याभा प्लाकि पंड्कि पंड्कि च्छमोटे मन आसाबे परभ कसब. येकी तरयूँँँँँँँँँँँँँँँँँँ (आशीये इन वाल लमदा 10-1) दोषेँँँँँँँँँँँँँँँँँअँँँँँँँँँँँँँँँँँँ (आशे ओओओओओओओओओओओओओँ (आशे ऑशे ऑशे ऐशे (आशे ऑशे ऐशे (आशे ऑशे ऐशे (आशे ऑशे (आशे ऑशे (आशे ऑशे (आशे ऑशे (आशे ஐशे (आशे ஐशे (आशे ஐशे (आशे ஐशे (आशे ऐशे (आशे ऐशे (आशे ऐशे (आशे ऐशे (आशே) (आशே) (आशே) (आशே) (आशே) (आशே) (आशே) (आशே) <table><tr><td colspan="2">Third visit at age 6 months</td></tr><tr><td>Actual child age:</td><td>Visit's date:</td></tr><tr><td>Feeding History</td><td>Exclusive breast feeding ( )Mixed feeding ( )Only milk formula ( )</td></tr><tr><td>Vaccination Update</td><td>Yes ( ) No ( ), Why: ......Reference number of HESN: ......</td></tr><tr><td colspan="2">Nurse's assessment</td></tr><tr><td>Weight</td><td>( ) kg</td></tr><tr><td>Length</td><td>( ) cm</td></tr><tr><td>Head Circumference</td><td>( ) cm</td></tr><tr><td>Temp</td><td></td></tr><tr><td colspan="2">(Measurements should be plotted on charts in the annexes of the passport)</td></tr><tr><td>Growth Follow up</td><td>Normal ( ) Abnormal ( ), Mention ......If abnormal, what is the action taken? Referral ( ) Follow up ( )</td></tr><tr><td>Child Development Assessment</td><td>Normal ( ) Abnormal ( ), Mention......(Data Should be registered in the Denver Form page 68)If Abnormal, What is the action taken? Referral ( ) Follow Up ( )RED FLAGS:☐ Does not try to get things that are in reach☐ Shows no affection for caregivers☐ Does not respond to sounds around him/her☐ Has difficulty getting things to mouth☐ Does not make vowel sounds (“ah”, “ell”, Oh)☐ Does not roll over in either direction☐ Does not laugh or make squealing sounds☐ Seems very stiff, with tight muscles☐ Does not bear weight on legs with suppor☐ Seems very floppy, like a rag do</td></tr><tr><td colspan="2">Doctor's assessment</td></tr><tr><td>Vision</td><td>Squint: Present ( ) Absent ( )Eye Reflex (Corneal): Normal ( ) Abnormal ( )Eye Reflex (Red): Normal ( ) Abnormal ( )Abnormality detected: ......If Abnormal, What is the action taken: Referral ( ) Follow Up ( )RED FLAGS:☐ Family History of retinoblastoma (at any age)☐ Parental concern regarding white pupil</td></tr></table> <table><tr><td>Hearing</td><td>Normal ( ) Abnormal ( )If Abnormal, What is the action taken: Referral ( ) Follow Up ( )RED FLAGS:☐ Family history of deafness☐ Parental concern regarding ability to respond to sounds☐ History suggestive of neonatal hypoxemia☐ History of neonatal hyperbilirubinemia</td></tr><tr><td>Oral/Dental health screening</td><td>Eruption of primary teeth started ( )No primary teeth erupted ( )Tongue tie / Ankyloglossia ( )Any unusual / pathological changes in oral tissues ( )Comments: ......Recommendations:......</td></tr><tr><td colspan="2">Physical Assessment</td></tr><tr><td>General Appearance:</td><td>( ) Normal ( ) Abnormal (specify):......</td></tr><tr><td>Head /Fontanels:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>EYE:</td><td>( ) Normal ( ) Abnormal☐ Abnormal red reflex ☐ Nystagmus ☐ Persistent strabismus☐ Corneal opacities ☐ Cataracts ☐ tearing or discharge</td></tr><tr><td>EARS:</td><td>( ) Normal ( ) Abnormal, Specify ...... ( ) Abnormal ABR</td></tr><tr><td>NOSE:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>MOUTH/THROAT:</td><td>( ) Normal ( ) Abnormal, Specify ...... ( ) Others ......</td></tr><tr><td>NECK:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>BREAST:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>ABDOMEN:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>C.V.S: Sounds:</td><td>S1...... S2...... added sounds: □ NOT □ YES,......</td></tr><tr><td>RESP. SYSTEM</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>HERNIA:</td><td>( ) NO ( ) YES</td></tr><tr><td>GENITALIA:</td><td>( ) Normal ( ) Abnormal, Specify ...... ......</td></tr><tr><td>SKIN:</td><td>Colour: □ Normal □ Abnormal, Pigmentation: □ NO □ YES___Rash: □ NO □ YES ......</td></tr><tr><td>MUSCULOSKEL-ETAL:</td><td>□ Normal □ Abnormal, Specify ......Hip: □ Normal □ Dislocation BACK: □ Normal □ Abnormal(●Spina bifida ●Scoliosis)</td></tr></table> <table><tr><td>NEUROLOGICAL SYSTEM:</td><td>1. Tone: □ Normal □ Hyporeflexia □ Hyperreflexia2. Power: □ Normal □ Abnormal, Specify ......3. Reflex: □ Normal □ Hyporeflexia □ Hyperreflexia4. Symmetry of Movement: □ NO □ YES5. Primitive Reflexes:I. The Moro Reflex :☐ Present:(☐ Symmetrical ☐ Asymmetrical) ☐ AbsentII. The Palmar Reflex : ☐ Present ☐ AbsentIII. The Rooting Reflex : ☐ Present ☐ AbsentIV. Spinal Galant : ☐ Present ☐ Absent</td></tr><tr><td colspan="2">Results of Physical Assessment Normal ( ) Abnormal ( ), Mention: ......If Abnormal, What is the action taken: Referral ( ) Follow Up ( )</td></tr><tr><td colspan="2">Exposure to Risk Factors</td></tr><tr><td>RISK ASSESSMENT:</td><td>( ) No risk ......( ) with risk ☐ A: ...... ☐ B:...... ☐ C:......Assessment of the risk detected: ......(For the Categories of the Children Exposed to risk please refer to pages 69-74)</td></tr><tr><td>Laboratory Investigations (If found)</td><td></td></tr><tr><td>Treatment(If found)</td><td></td></tr><tr><td>Overall Findings/Plan</td><td>( ) Normal( ) Abnormal findings: ......PLAN:☐ Follow-up☐ Medication ......☐ Health Education: ......☐ Referral: ☐ YES ☐ NO</td></tr><tr><td>Next visit's date:</td><td></td></tr><tr><td colspan="2">Physician's name: ...... signature: ...... Date: ......</td></tr></table> - عند نهايه الشهر السادس من عمر المولود يجب البدء في اعطايه الاغذيه التكميليه بحيث تكون سهله الهضم مع الاستمرار والحرص علي الرضاعه الطبيعيه حتي بلوغه عامين. - الوجبات الغذاييه التكميليه يجب ان تكون متنوعه ومتوارنه، بحيث تكون (٢) وجبات مهرسه او نصف صلبه تزداد تدريبيا في الكميه والقوام بزياده العمر. من انواع الاغذيه التكميليه للمولود في هذا العمر: ارز مسلوق خضر مسلوق بسكويت غير محلي العنايه بصحه قم واسنان الرضيع يجب علي الام المحافظه علي صحه قم واسنان مولودها حيث يبدا بزوع الاسنان بعد عمر السته اشهر مما تحتاج لعنايه خاصه بكيفيه تنظيفها لتجنب تسوسها. فيما يلي بعض الارشادات التي تخص الاسنان: التسيين (بزوع الاسنان): في بعض الاحيان يترافق بزوع الاسنان لدي الرضع مع بعض الالام والاززاع مع زياده افراز اللعاب وخرجه من الفم، ولتحفيف تلك الاعراض ينص باستخدم حلقات التسيين المختلفه، ويفصل استخدام حلقات التسيين البلاستيكيه الباره (المملوعه بالاماء او الجل) التي يمكن وضعها بالثلاجه، ولا ينص باستخدام جل التسيين الذي يوضع مباشره علي اللثه. تنظيف اسنان الرضع: ● مع بزوع الاسنان اللبنيه في عمر السنه اشهر تقريبا يتم البدء بتنظيف تنظيف الاسنان بقطعه شاش او قطن مبلله بالاماء فقط بعد كل وجبه. ● عند اكمال الطفعل عامه الاول يمكن للام استخدام فرشه اسنان صغيره مع كميه قليله جدا من معجون الاسنان المحتوي علي الفلورايد مع الحرص علي مسح الاسنان بعد ذلك بالاماء لازاله المعجون وذلك لعدم قدره الطفعل علي المضطه. تسوس اسنان الرضيع: نجد ان اسنان الرضيع اكثر عرضه للاصابه بالتسوس وذلك بسبب عدم اكتمال تكون السن، لما يجب علي الام اهتمام بنظافه الاسنان الرضيع يوميا من عمر سنه اشهر. من العلامات الاوليه للتسوس ظهور بقع او خطوط بيضاء اللون علي سطح السن والتي سرعان ما تؤدي الي تكسر السن وظهر التسوس بلونه البني او الاسود. لما يجب متابعه الطفل لدي طبيب الاسنان مع الحرص علي اتباع الطرق الوقاييه وتجنب اكثر الاغذيه السكريه. <table><tr><td colspan="2">Fourth visit at age 9 months</td></tr><tr><td>Actual child age:</td><td>Visit's date:</td></tr><tr><td>Feeding History</td><td>Exclusive breast feeding ( ) Only milk formula ( ) Mixed feeding ( ) Complementary Feeding ( )</td></tr><tr><td>Vaccination Update</td><td>Yes ( ) No ( ), Why: ...... Reference number of HESN: ......</td></tr><tr><td colspan="2">Nurse's assessment</td></tr><tr><td>Weight</td><td>( ) kg</td></tr><tr><td>Length</td><td>( ) cm</td></tr><tr><td>Head Circumference</td><td>( ) cm</td></tr><tr><td>Temp</td><td></td></tr><tr><td colspan="2">(Measurements should be plotted on charts in the annexes of the passport)</td></tr><tr><td>Growth Follow up</td><td>Normal ( ) Abnormal ( ), Mention ...... If abnormal, what is the action taken? Referral ( ) Follow up ( )</td></tr><tr><td>Child Development Assessment</td><td>Normal ( ) Abnormal ( ), Mention......(Data Should be registered in the Denver Form page 68)If Abnormal, What is the action taken? Referral ( ) Follow Up ( ) RED FLAGS:☐ Does not sit with help☐ Does not look where you point☐ Does not respond to own name☐ Does not play any games involving back and forth play☐ Does not say single words like “ma-ma” or “da-da”☐ Does not seem to recognize familiar people☐ Does not transfer toys from his/her hand to others</td></tr><tr><td colspan="2">Doctor's assessment</td></tr><tr><td>Vision</td><td>Squint: Present ( ) Absent ( )Eye Reflex (Corneal): Normal ( ) Abnormal ( )Eye Reflex (Red): Normal ( ) Abnormal ( )Abnormality detected: ......If Abnormal, What is the action taken: Referral ( ) Follow Up ( )RED FLAGS:☐ Family History of retinoblastoma (at any age)☐ Parental concern regarding white pupil</td></tr></table> <table><tr><td>Hearing</td><td>Normal ( ) Abnormal ( ), Specify ......If Abnormal, What is the action taken: Referral ( ) Follow Up ( ) RED FLAGS:□ Family history of deafness□ Parental concern regarding ability to respond to sounds□ History suggestive of neonatal hypoxemia□ History of neonatal hyperbilirubinemia</td></tr><tr><td>Oral/Dental health screening</td><td>Eruption of primary teeth started ( )No primary teeth erupted ( )Tongue tie / Ankyloglossia ( )Any unusual / pathological changes in oral tissues ( )Comments: ......Recommendations:......</td></tr><tr><td colspan="2">Physical Assessment</td></tr><tr><td>General Appearance:</td><td>( ) Normal ( ) Abnormal (specify):......</td></tr><tr><td>Head /Fontanels:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>EYE:</td><td>( ) Normal ( ) Abnormal□ Abnormal red reflex □ Nystagmus □ Persistent strabismus□ Corneal opacities □ Cataracts □ tearing or discharge</td></tr><tr><td>EARS:</td><td>( ) Normal ( ) Abnormal, Specify ...... ( ) Abnormal ABR</td></tr><tr><td>NOSE:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>MOUTH/THROAT:</td><td>( ) Normal ( ) Abnormal, Specify ...... ( ) Others ......</td></tr><tr><td>NECK:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>BREAST:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>ABDOMEN:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>C.V.S: Sounds:</td><td>S1...... S2...... added sounds: □ NOT □ YES,......</td></tr><tr><td>RESP. SYSTEM</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>HERNIA:</td><td>( ) NO ( ) YES</td></tr><tr><td>GENITALIA:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>SKIN:</td><td>Colour: □ Normal □ Abnormal, Pigmentation: □NO □YES,......Rash: □ NO □ YES ......</td></tr><tr><td>MUSCULOSKEL-ETAL:</td><td>□ Normal □ Abnormal ......Hip: □ Normal □ Dislocation BACK: □ Normal □ Abnormal(●Spina bifida ●Scoliosis)</td></tr></table> <table><tr><td>NEUROLOGICAL SYSTEM:</td><td>1. Tone: □ Normal □ Hypotonia □ Hypertonia2. Power: □ Normal □ Abnormal, Specify ......3. Reflex: □ Normal □ Hyperoflexia □ Hyperreflexia4. Symmetry of Movement: □ NO □ YES5. Primitive Reflexes:I. The Moro Reflex:□ Present:(□ Symmetrical □ Asymmetrical) □ AbsentII. The Palmar Reflex: □ Present □ AbsentIII. The Rooting Reflex: □ Present □ AbsentIV. Spinal Galant: □ Present □ Absent</td></tr><tr><td colspan="2">Results of Physical Assessment Normal ( ) Abnormal ( ), Mention: ......If Abnormal, What is the action taken: Referral ( ) Follow Up ( )</td></tr><tr><td colspan="2">Exposure to Risk Factors</td></tr><tr><td>RISK ASSESSMENT:</td><td>( ) No risk ......( ) with risk □ A: ...... □ B: ...... □ C: ......Assessment of the risk detected: ......(For the Categories of the Children Exposed to risk please refer to pages 69-74)</td></tr><tr><td>Laboratory Investigations (If found)</td><td></td></tr><tr><td>Treatment (If found)</td><td></td></tr><tr><td>Overall Findings/ Plan</td><td>( ) Normal( ) Abnormal findings: ......PLAN:□ Follow-up□ Medication ......□ Health Education: ......□ Referral: □ YES □ NO</td></tr><tr><td>Next visit's date:</td><td></td></tr><tr><td colspan="2">Physician's name: ...... signature: ...... Date: ......</td></tr></table> يحرك الاشياء الصغيره بين يديه بانسيابيه تقليد الاصوات والايماعات للاخرين الجلوس دون مساعده احد اشهر اتخاذ وضعيه الوقوف بالاستند بالاشياء يضع الاشياء في فمه <table><tr><td colspan="2">Fifth visit at age 12 months</td></tr><tr><td colspan="2">Actual child age: Visit's date:</td></tr><tr><td>Feeding History</td><td>Exclusive breast feeding ( ) Only milk formula ( ) Mixed feeding ( ) Complementary Feeding ( )</td></tr><tr><td>Vaccination Update</td><td>Yes ( ) No ( ), Why: ....Reference number of HESN: ....</td></tr><tr><td colspan="2">Nurse's assessment</td></tr><tr><td>Weight</td><td>( ) kg</td></tr><tr><td>Length</td><td>( ) cm</td></tr><tr><td>Head Circumference</td><td>( ) cm</td></tr><tr><td>Temp</td><td></td></tr><tr><td colspan="2">(Measurements should be plotted on charts in the annexes of the passport)</td></tr><tr><td>Growth Follow up</td><td>Normal ( ) Abnormal ( ), Mention ....If abnormal, what is the action taken? Referral ( ) Follow up ( )</td></tr><tr><td>Child Development Assessment</td><td>Normal ( ) Abnormal ( ), Mention.....(Data Should be registered in the Denver Form page 68)If Abnormal, What is the action taken? Referral ( ) Follow Up ( )RED FLAGS:☐ Does not crawl ☐ Does not stand when supported☐ Does not search for things that he/she see you hide ☐ Does not point to things☐ Does not say single words like “ma-ma” or “da-da”</td></tr><tr><td colspan="2">Doctor's assessment</td></tr><tr><td>Vision</td><td>Squint: Present ( ) Absent ( )Eye Reflex (Corneal): Normal ( ) Abnormal ( )Eye Reflex (Red): Normal ( ) Abnormal ( )Abnormality detected: ......If Abnormal, What is the action taken: Referral ( ) Follow Up ( )RED FLAGS:☐ Family History of retinoblastoma (at any age)☐ Parental concern regarding white pupil</td></tr><tr><td>Hearing</td><td>Normal ( ) Abnormal ( ), Specify ......If Abnormal, What is the action taken: Referral ( ) Follow Up ( )RED FLAGS:☐ Family history of deafness☐ Parental concern regarding ability to respond to sounds☐ History suggestive of neonatal hypoxemia☐ History of neonatal hyperbilirubinemia</td></tr></table> <table><tr><td>Oral/Dental health screening</td><td>Normal/healthy ( )Carious / decayed teeth ( )Other condition ( ), Mention ......Parents/ caregivers clean the child's teeth Yes ( ) No ( )Comments: ......Recommendations: ......</td></tr><tr><td colspan="2">Physical Assessment</td></tr><tr><td>General Appearance:</td><td>( ) Normal ( ) Abnormal (specify): ......</td></tr><tr><td>Head /Fontanels:</td><td>( ) Normal ( ) Not: ......</td></tr><tr><td>EYE:</td><td>( ) Normal ( ) Abnormal□ Abnormal red reflex □ Nystagmus □ Persistent strabismus□ Corneal opacities □ Cataracts □ tearing or discharge</td></tr><tr><td>EARS:</td><td>( ) Normal ( ) Abnormal, Specify ...... ( ) Abnormal ABR</td></tr><tr><td>NOSE:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>MOUTH/THROAT:</td><td>( ) Normal ( ) Abnormal, Specify ...... ( ) Others ......</td></tr><tr><td>NECK:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>BREAST:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>ABDOMEN:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>C.V.S: Sounds:</td><td>S1...... S2...... added sounds: □ NOT □ YES,......</td></tr><tr><td>RESP. SYSTEM</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>HERNIA:</td><td>( ) NO ( ) YES</td></tr><tr><td>GENITALIA:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>SKIN:</td><td>Colour: □ Normal □ Abnormal, Pigmentation: □ NO □ YES ......Rash: □ NO □ YES ......</td></tr><tr><td>MUSCULOSKEL-ETAL:</td><td>□ Normal □ Abnormal ...... Hip: □ Normal □ DislocationBACK: □ Normal □ Abnormal (●Spina bifida •Scoliosis)</td></tr><tr><td>NEUROLOGICAL SYSTEM:</td><td>1. Tone: □ Normal □ Hypotonia □ Hypertonia2. Power: □ Normal □ Abnormal, Specify ......3. Reflex: □ Normal □ Hyporeflexia □ Hyperreflexia4. Symmetry of Movement: □ NO □ YES</td></tr><tr><td colspan="2">Results of Physical Assessment Normal ( ) Abnormal ( ), Mention: ......If Abnormal, What is the action taken: Referral ( ) Follow Up ( )</td></tr></table> <table><tr><td colspan="2">Exposure to Risk Factors</td></tr><tr><td>RISK ASSESSMENT:</td><td>( ) No risk ......( ) with risk □ A: ...... □ B:...... □ C:......Assessment of the risk detected: ......(For the Categories of the Children Exposed to risk please refer to pages 69-74)</td></tr><tr><td>Hemoglobin Test (screening for iron deficiency anemia</td><td>Hb ( ) Normal ( ) Abnormal ( )If Abnormal, What is the action taken: Referral ( ) Follow Up ( )Recommendation: ......</td></tr><tr><td>Laboratory Investigations (If found)</td><td></td></tr><tr><td>Treatment (If found)</td><td></td></tr><tr><td>Overall Findings/ Plan</td><td>( ) Normal( ) Abnormal findings: ......PLAN:☐ Follow-up☐ Medication......☐ Health Education:......☐ Referral: ☐ YES ☐ NO</td></tr><tr><td>Next visit's date:</td><td></td></tr><tr><td colspan="2">Physician's name: ...... signature: ...... Date: ......</td></tr></table> توفير بييه محيطه امنه للطفل في هذا العمر لانه يميل لاستكشاف ما حوله مع ابعاد الادوات الخطره عن متناوله وتغطيه مقابس الكهرباء لتجنب الاصابات والحوادث المنزليه <table><tr><td colspan="2">Sixth visit at age 18 months</td></tr><tr><td>Actual child age:</td><td>Visit's date:</td></tr><tr><td>Feeding History</td><td>Exclusive breast feeding ( ) Only milk formula ( ) Mixed feeding ( ) Complementary Feeding ( )</td></tr><tr><td>Vaccination Update</td><td>Yes ( ) No ( ), Why: ......Reference number of HESN: ......</td></tr><tr><td colspan="2">Nurse's assessment</td></tr><tr><td>Weight</td><td>( ) kg</td></tr><tr><td>Height</td><td>( ) cm</td></tr><tr><td>Head Circumference</td><td>( ) cm</td></tr><tr><td>Temp</td><td></td></tr><tr><td colspan="2">(Measurements should be plotted on charts in the annexes of the passport)</td></tr><tr><td>Growth Follow up</td><td>Normal ( ) Abnormal ( ), Mention ......If abnormal, what is the action taken? Referral ( ) Follow up ( )</td></tr><tr><td>Child Development Assessment</td><td>Normal ( ) Abnormal ( ), Mention......(Data Should be registered in the Denver Form page 68)If Abnormal, What is the action taken? Referral ( ) Follow Up ( )RED FLAGS:☐ Does not point to show things to others☐ Does not gain new words☐ Cannot walk☐ Does not have at least six words☐ Does not know what familiar things are for☐ Loses skills they once had☐ Does not copy others☐ Does not notice or mind when a caregiver leaves or returns</td></tr><tr><td colspan="2">Doctor's assessment</td></tr><tr><td>Vision</td><td>Squint: Present ( ) Absent ( )Eye Reflex (Corneal): Normal ( ) Abnormal ( )Eye Reflex (Red): Normal ( ) Abnormal ( )Abnormality detected: ......If Abnormal, What is the action taken: Referral ( ) Follow Up ( )RED FLAGS:☐ Family History of retinoblastoma☐ Neurodevelopment delay ☐ Poor tracking☐ Parental concern raised regarding white pupil☐ Persistent or occasional eye deviation or strabismus at any time</td></tr></table> <table><tr><td>Hearing</td><td>Normal ( ) Abnormal ( ), Specify ......If Abnormal, What is the action taken: Referral ( ) Follow Up ( ) RED FLAGS:☐ Family history of deafness ☐ Neonatal CMV Infection☐ Parenteral concern regarding ability to respond to sounds ☐ Head trauma☐ History of suggestive of neonatal hypoxemia ☐ History of bacterial meningitis☐ History of neonatal hyperbilirubinemia☐ Exposure to ototoxic medication☐ Parent express concern of hearing problem, language, or developmental delay.☐ Syndrome associated with hearing loss, e.g., Alport Syndrome</td></tr><tr><td>Oral/Dental health screening</td><td>Normal/healthy ( )Carious / decayed teeth ( )Dental abscess ( )Other condition ( ), Mention ......Parents/ caregivers clean the child's teeth Yes ( ) No ( )Comments: ......Recommendations: ......</td></tr><tr><td colspan="2">Physical Assessment</td></tr><tr><td>General Appearance:</td><td>( ) Normal ( ) Abnormal (specify): ......</td></tr><tr><td>Head /Fontanels:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>EYE:</td><td>( ) Normal ( ) Abnormal□ Abnormal red reflex □ Nystagmus □ Persistent strabismus□ Corneal opacities □ Cataracts □ tearing or discharge</td></tr><tr><td>EARS:</td><td>( ) Normal ( ) Abnormal, Specify ...... ( ) Abnormal ABR</td></tr><tr><td>NOSE:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>MOUTH/THROAT:</td><td>( ) Normal ( ) Abnormal, Specify ...... ( ) Others ......</td></tr><tr><td>NECK:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>BREAST:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>ABDOMEN:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>C.V.S: Sounds:</td><td>S1...... S2...... added sounds: □ NOT □ YES,......</td></tr><tr><td>RESP. SYSTEM</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>HERNIA:</td><td>( ) NO ( ) YES</td></tr><tr><td>GENITALIA:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>SKIN:</td><td>Colour: □ Normal □ Abnormal, Pigmentation: □ NO □ YES ......Rash: □ NO □ YES ......</td></tr></table> <table><tr><td>MUSCULOSKEL-ETAL:</td><td>□ Normal □ Abnormal ......Hip: □ Normal □ Dislocation BACK: □ Normal □ Abnormal(●Spina bifida ●Scoliosis)</td></tr><tr><td>NEUROLOGICAL SYSTEM:</td><td>1. Tone: □ Normal □ Hypotonia □ Hypertonia2. Power: □ Normal □ Abnormal, Specify ......3. Reflex: □ Normal □ Hyperoflexia □ Hyperreflexia4. Symmetry of Movement: □ NO □ YES</td></tr><tr><td colspan="2">Results of Physical Assessment Normal ( ) Abnormal ( ), Mention: ......If Abnormal, What is the action taken: Referral ( ) Follow Up ( )</td></tr><tr><td colspan="2">Exposure to Risk Factors</td></tr><tr><td>RISK ASSESSMENT:</td><td>( ) No risk ......( ) with risk □ A: ...... □ B: ...... □ C: ......Assessment of the risk detected: ......(For the Categories of the Children Exposed to risk please refer to pages 69-74)</td></tr><tr><td>Laboratory Investigations (If found)</td><td></td></tr><tr><td>Treatment1</td><td></td></tr><tr><td>Overall Findings/ Plan</td><td>( ) Normal( ) Abnormal findings: ......PLAN:□ Follow-up□ Medication ......□ Health Education: ......□ Referral: □ YES □ NO</td></tr><tr><td>Next visit's date:</td><td></td></tr><tr><td colspan="2">Physician's name: ...... signature: ...... Date: ......</td></tr></table> <table><tr><td colspan="2">Seventh visit at age 24 months (2 Years)</td></tr><tr><td>Actual child age:</td><td>Visit's date:</td></tr><tr><td>Feeding History</td><td>Exclusive breast feeding ( ) Only milk formula ( ) Mixed feeding ( ) Complementary Feeding ( )</td></tr><tr><td>Vaccination Update</td><td>Yes ( ) No ( ), Why: ....Reference number of HESN: ....</td></tr><tr><td colspan="2">Nurse's assessment</td></tr><tr><td>Weight</td><td>( ) kg</td></tr><tr><td>Height</td><td>( ) cm</td></tr><tr><td>Head Circumference</td><td>( ) cm</td></tr><tr><td>Temp</td><td></td></tr><tr><td>BMI</td><td></td></tr><tr><td colspan="2">(Measurements should be plotted on charts in the annexes of the passport)</td></tr><tr><td>Growth Follow up</td><td>Normal ( ) Abnormal ( ), Mention ....If abnormal, what is the action taken? Referral ( ) Follow up ( )</td></tr><tr><td>Child Development Assessment</td><td>Normal ( ) Abnormal ( ), Mention.....(Data Should be registered in the Denver Form page 68)If Abnormal, What is the action taken? Referral ( ) Follow Up ( )RED FLAGS:☐ Does not use two-word phrases (e.g., “drink milk”)☐ Does not walk steadily☐ Does not know what to do with common things, like☐ Loses skills they once had brush, phone, fork, spoon☐ Does not follow simple instructions☐ Does not copy actions and words</td></tr><tr><td colspan="2">Doctor's assessment</td></tr><tr><td>Vision</td><td>Squint: Present ( ) Absent ( )Eye Reflex (Corneal): Normal ( ) Abnormal ( )Eye Reflex (Red): Normal ( ) Abnormal ( )Abnormality detected: ......If Abnormal, What is the action taken: Referral ( ) Follow Up ( )RED FLAGS:☐ Family History of retinoblastoma ☐ Neurodevelopment delay☐ Parental concern raised regarding white pupil ☐ Poor tracking☐ Persistent or occasional eye deviation or strabismus at any time</td></tr></table> <table><tr><td>Hearing</td><td>Normal ( ) Abnormal ( ), Specify ......If Abnormal, What is the action taken: Referral ( ) Follow Up ( ) RED FLAGS:☐ Family history of deafness ☐ Neonatal CMV Infection☐ Parenteral concern regarding ability to respond to sounds ☐ Head trauma☐ History of suggestive of neonatal hypoxemia ☐ History of bacterial meningitis☐ History of neonatal hyperbilirubinemia ☐ Exposure to ototoxic medication☐ Parent express concern of hearing problem, language, or developmental delay.☐ Syndrome associated with hearing loss, e.g., Alport Syndrome</td></tr><tr><td>Oral/Dental health screening</td><td>Normal/healthy ( )Carious / decayed teeth ( )Dental abscess ( )Other condition ( ), Mention ......Parents/ caregivers clean the child's teeth Yes ( ) No ( )Comments: ......Recommendations: ......</td></tr><tr><td colspan="2">Physical Assessment</td></tr><tr><td>General Appearance:</td><td>( ) Normal ( ) Abnormal (specify): ......</td></tr><tr><td>Head /Fontanels:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>EYE:</td><td>( ) Normal ( ) Abnormal□ Abnormal red reflex □ Nystagmus □ Persistent strabismus□ Corneal opacities □ Cataracts □ tearing or discharge</td></tr><tr><td>EARS:</td><td>( ) Normal ( ) Abnormal, Specify ...... ( ) Abnormal ABR</td></tr><tr><td>NOSE:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>MOUTH/THROAT:</td><td>( ) Normal ( ) Abnormal, Specify ...... ( ) Others ......</td></tr><tr><td>NECK:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>BREAST:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>ABDOMEN:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>C.V.S: Sounds:</td><td>S1...... S2...... added sounds: □ NOT □ YES,......</td></tr><tr><td>RESP. SYSTEM</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>HERNIA:</td><td>( ) NO ( ) YES</td></tr><tr><td>GENITALIA:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>SKIN:</td><td>Colour: □ Normal □ Abnormal, Pigmentation: □ NO □ YES ......Rash: □ NO □ YES ......</td></tr></table> <table><tr><td>MUSCULOSKEL-ETAL:</td><td>□ Normal □ Abnormal ......Hip: □ Normal □ Dislocation BACK: □ Normal □ Abnormal(●Spina bifida ●Scoliosis)</td></tr><tr><td>NEUROLOGICAL SYSTEM:</td><td>1. Tone: □ Normal □ Hyptoniao □ Hypertonia2. Power: □ Normal □ Abnormal, Specify ......3. Reflex: □ Normal □ Hyporeflexia □ Hyperreflexia4. Symmetry of Movement: □ NO □ YES</td></tr><tr><td colspan="2">Results of Physical Assessment Normal ( ) Abnormal ( ), Mention: ......If Abnormal, What is the action taken: Referral ( ) Follow Up ( )</td></tr><tr><td colspan="2">Exposure to Risk Factors</td></tr><tr><td>RISK ASSESSMENT:</td><td>( ) No risk ......( ) with risk □ A: ...... □ B:...... □ C:......Assessment of the risk detected: ......(For the Categories of the Children Exposed to risk please refer to pages 69-74)</td></tr><tr><td>Laboratory Investigations (If found)</td><td></td></tr><tr><td>Treatment (If found)</td><td></td></tr><tr><td>Overall Findings/ Plan</td><td>( ) Normal( ) Abnormal findings: ......PLAN:□ Follow-up□ Medication ......□ Health Education: ......□ Referral: □ YES □ NO</td></tr><tr><td>Next visit's date:</td><td></td></tr><tr><td colspan="2">Physician's name: ...... signature: ...... Date: ......</td></tr></table> <table><tr><td colspan="2">Eighth visit at age 3 Years</td></tr><tr><td colspan="2">Actual child age: Visit's date:</td></tr><tr><td>Feeding History</td><td></td></tr><tr><td>Vaccination Update</td><td>Complete vaccination according to the national schedule immunization (up to 2 years)Yes ( ) No ( ), Why: ......</td></tr><tr><td colspan="2">Nurse's assessment</td></tr><tr><td>Weight</td><td>( ) kg</td></tr><tr><td>Height</td><td>( ) cm</td></tr><tr><td>Temp</td><td></td></tr><tr><td>BMI</td><td></td></tr><tr><td>Blood Pressure (BP)</td><td></td></tr><tr><td colspan="2">(Measurements should be plotted on charts in the annexes of the passport)</td></tr><tr><td>Growth Follow up</td><td>Normal ( ) Abnormal ( ), Mention ......If abnormal, what is the action taken? Referral ( ) Follow up ( )</td></tr><tr><td>Child Development Assessment</td><td>Normal ( ) Abnormal ( ), Mention......(Data Should be registered in the Denver Form page 68)If Abnormal, What is the action taken? Referral ( ) Follow Up ( )RED FLAGS AT 24 MONTHS OF AGE:☐ Falls down a lot or have trouble with stairs☐ Does not speak in sentences☐ Drools or have very unclear speech ☐ Does not make eye contact☐ Does not understand simple instructions ☐ Loses skills they once had☐ Does not play, pretend, or make-believe☐ Cannot work simple toys (such as peg boards, simple puzzles, turning handle☐ Does not want to play with other children or with toys</td></tr><tr><td colspan="2">Doctor's assessment</td></tr><tr><td>Vision</td><td>Squint : Present ( ) Absent ( )Eye Reflex (Corneal): Normal ( ) Abnormal ( )Eye Reflex (Red): Normal ( ) Abnormal ( )Abnormality detected: ......If Abnormal, What is the action taken: Referral ( ) Follow Up ( )RED FLAGS BIRTH ONWARDS:☐ Family History of retinoblastoma ☐ Neurodevelopment delay☐ Parental concern raised regarding white pupil ☐ Poor tracking☐ Persistent or occasional eye deviation or strabismus at any time</td></tr></table> <table><tr><td>Hearing</td><td>Normal ( ) Abnormal ( ), Specify ......If Abnormal, What is the action taken: Referral ( ) Follow Up ( )RED FLAGS:□ Family history of deafness□ Parental concern regarding ability to respond to sounds□ History suggestive of neonatal hypoxemia□ History of neonatal hyperbilirubinemia</td></tr><tr><td>Oral/Dental health screening</td><td>Normal/healthy ( )Carious / decayed teeth ( )Dental abscess ( )Mandibular Protrusion ( )Orthodontic Problems ( )Mouth breathing ( )Other condition ( ), Mention ......Parents/ caregivers clean the child's teeth Yes ( ) No ( )Comments: ......Recommendations: ......</td></tr><tr><td colspan="2">Physical Assessment</td></tr><tr><td>General Appearance:</td><td>( ) Normal ( ) Abnormal (specify): ......</td></tr><tr><td>Head /Fontanels:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>EYE:</td><td>( ) Normal ( ) Abnormal□ Abnormal red reflex □ Nystagmus □ Persistent strabismus□ Corneal opacities □ Cataracts □ tearing or discharge</td></tr><tr><td>EARS:</td><td>( ) Normal ( ) Abnormal, Specify ...... ( ) Abnormal ABR</td></tr><tr><td>NOSE:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>MOUTH/THROAT:</td><td>( ) Normal ( ) Abnormal, Specify ...... ( ) Others ......</td></tr><tr><td>NECK:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>BREAST:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>ABDOMEN:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>C.V.S: Sounds:</td><td>S1...... S2...... added sounds: q NOT q YES,......</td></tr><tr><td>RESP. SYSTEM</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>HERNIA:</td><td>( ) NO ( ) YES</td></tr><tr><td>GENITALIA:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>SKIN:</td><td>Colour: □ Normal □ Abnormal, Pigmentation: □ NO □ YES___Rash: □ NO □ YES ......</td></tr></table> <table><tr><td>MUSCULOSKEL-ETAL:</td><td colspan="2">☐ Normal ☐ Abnormal ......Hip: ☐ Normal ☐ Dislocation BACK: ☐ Normal ☐ Abnormal(●Spina bifida ●Scoliosis)</td></tr><tr><td>NEUROLOGICAL SYSTEM:</td><td colspan="2">1. Tone: ☐ Normal ☐ Hypotonia ☐ Hypertonia2. Power: ☐ Normal ☐ Abnormal, Specify ......3. Reflex: ☐ Normal ☐ Hyporeflexia ☐ Hyperreflexia4. Symmetry of Movement: ☐ NO ☐ YES</td></tr><tr><td colspan="2">Results of Physical Assessment Normal ( ) Abnormal ( ), Mention: ......</td><td></td></tr><tr><td colspan="2">If Abnormal, What is the action taken: Referral ( ) Follow Up ( )</td><td></td></tr><tr><td colspan="3">Exposure to Risk Factors</td></tr><tr><td>RISK ASSESSMENT:</td><td colspan="2">( ) No risk ......( ) with risk ☐ A: ...... ☐ B:...... ☐ C:......Assessment of the risk detected: ......(For the Categories of the Children Exposed to risk please refer to pages 69-74)</td></tr><tr><td>Laboratory Investigations (If found)</td><td colspan="2"></td></tr><tr><td>Treatment (If found)</td><td colspan="2"></td></tr><tr><td>Overall Findings/ Plan</td><td colspan="2">( ) Normal( ) Abnormal findings: ......PLAN:☐ Follow-up☐ Medication ......☐ Health Education: ......☐ Referral: ☐ YES ☐ NO</td></tr><tr><td>Next visit's date:</td><td colspan="2"></td></tr><tr><td colspan="3">Physician's name: ...... signature: ...... Date: ......</td></tr></table> عند ظهور اي اعراض مرضيه علي الطفل او اصابه الطفل بيلتهابات او تضخم اللوز واللحميه يجب مراجعه الطبيب، مع المحافظه علي اعطايه السوايل الكافيه. <table><tr><td colspan="2">Ninth visit at age 4 Years</td></tr><tr><td colspan="2">Actual child age: Visit's date:</td></tr><tr><td>Feeding History</td><td></td></tr><tr><td>Vaccination Update</td><td>Complete vaccination according to the national schedule immunization (up to 2 years)Yes ( ) No ( ), Why: ......</td></tr><tr><td colspan="2">Nurse's assessment</td></tr><tr><td>Weight</td><td>( ) kg</td></tr><tr><td>Height</td><td>( ) cm</td></tr><tr><td>Temp</td><td></td></tr><tr><td>BMI</td><td></td></tr><tr><td colspan="2">Blood Pressure (BP)</td></tr><tr><td colspan="2">(Measurements should be plotted on charts in the annexes of the passport)</td></tr><tr><td>Growth Follow up</td><td>Normal ( ) Abnormal ( ), Mention ......If abnormal, what is the action taken? Referral ( ) Follow up ( )</td></tr><tr><td>Child Development Assessment</td><td>Normal ( ) Abnormal ( ), Mention......(Data Should be registered in the Denver Form page 68)If Abnormal, What is the action taken? Referral ( ) Follow Up ( )RED FLAGS:□ Cannot jump in place □ Does not follow tree-part command□ Has trouble scribbling □ Cannot retell a favorite story□ Resist dressing, sleeping, and using the toilet □ Speaks unclearly□ Does not use “me” and “you” correctly □ Loses skills they once had□ Does not understand “same” and “different”□ Show no interest in interactive games or make believes□ Ignores other children or do not respond to people outside the family</td></tr><tr><td colspan="2">Doctor's assessment</td></tr><tr><td>Vision</td><td>Squint: Present ( ) Absent ( )Eye Reflex (Corneal): Normal ( ) Abnormal ( )Eye Reflex (Red): Normal ( ) Abnormal ( )Abnormality detected: ......If Abnormal, What is the action taken: Referral ( ) Follow Up ( )RED FLAGS BIRTH ONWARDS:□ Family History of retinoblastoma □ Neurodevelopment delay□ Parental concern raised regarding white pupil □ Poor tracking□ Persistent or occasional eye deviation or strabismus at any time</td></tr></table> <table><tr><td>Hearing</td><td>Normal ( ) Abnormal ( ), Specify ......If Abnormal, What is the action taken: Referral ( ) Follow Up ( ) RED FLAGS:□ Family history of deafness □ Neonatal CMV Infection□ Parenteral concern regarding ability to respond to sounds□ Head trauma □ History of suggestive of neonatal hypoxemia□ History of bacterial meningitis □ Exposure to ototoxic medication□ History of neonatal hyperbilirubinemia □ Parent express concern of hearing problem, language, or developmental delay.□ Syndrome associated with hearing loss, e.g., Alport Syndrome</td></tr><tr><td>Oral/Dental health screening</td><td>Normal/healthy ( )Carious / decayed teeth ( )Dental abscess ( )Mandibular Protrusion ( )Orthodontic Problems ( )Mouth breathing ( )Other condition ( ), Mention ......Parents/ caregivers clean the child's teeth Yes ( ) No ( )Comments: ......Recommendations: ......</td></tr><tr><td colspan="2">Physical Assessment</td></tr><tr><td>General Appearance:</td><td>( ) Normal ( ) Abnormal (specify): ......</td></tr><tr><td>Head /Fontanels:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>EYE:</td><td>( ) Normal ( ) Abnormal☐ Abnormal red reflex ☐ Nystagmus ☐ Persistent strabismus☐ Corneal opacities ☐ Cataracts ☐ tearing or discharge</td></tr><tr><td>EARS:</td><td>( ) Normal ( )Abnormal, Specify ...... ( ) Abnormal ABR</td></tr><tr><td>NOSE:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>MOUTH/THROAT:</td><td>( ) Normal ( ) Abnormal, Specify ...... ( ) Others ......</td></tr><tr><td>NECK:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>BREAST:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>ABDOMEN:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>C.V.S: Sounds:</td><td>S1...... S2...... added sounds: □ NOT □ YES,......</td></tr><tr><td>RESP. SYSTEM</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>HERNIA:</td><td>( ) NO ( ) YES</td></tr><tr><td>GENITALIA:</td><td>( ) Normal ( ) Abnormal, Specify ......</td></tr><tr><td>SKIN:</td><td>Colour: □ Normal □ Abnormal, Pigmentation: □ NO □ YES ......Rash: □ NO □ YES ......</td></tr></table> <table><tr><td>MUSCULOSKEL-ETAL:</td><td>Normal AbnormalHip: Normal Dislocation BACK: Normal Abnormal(Spina bifida Scoliosis)</td></tr><tr><td>NEUROLOGICAL SYSTEM:</td><td>Tone: Normal Hypotonia HypertoniaPower: Normal Abnormal, Specify ....Reflex: Normal Hyperoflexia HyperreflexiaSymmetry of Movement: NO YES</td></tr><tr><td colspan="2">Results of Physical Assessment Normal ( ) Abnormal ( ), Mention: ....If Abnormal, What is the action taken: Referral ( ) Follow Up ( )</td></tr><tr><td colspan="2">Exposure to Risk Factors</td></tr><tr><td>RISK ASSESSMENT:</td><td>( ) No risk ....( ) with risk A: .... B: .... C:Assessment of the risk detected: (For the Categories of the Children Exposed to risk please refer to pages 69-74)</td></tr><tr><td>Laboratory Investigations (If found)</td><td></td></tr><tr><td>Treatment (If found)</td><td></td></ …(60,075 more chars)