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Available Forms

Complete Packet- 12 months

Bright Futures Previsit Questionnaire 12 Month Visit

For us to provide you and your child with the best possible health care, we would like to know how things are going. Please answer all of the questions. Thank you.

What would you like to talk about today?

We are interested in answering your questions. Please check off the boxes for the topics you would like to discuss the most today.

Questions About Your Child

Your Growing and Developing Child

Lead Risk Assessment

TB Risk Assessmet

If yes, to any of the above, the child has and increased risk of TB infection and should have a TST/IGRA. All children with a positive TST/IGRA result must have a medical evaluation, including a chest X-ray. Treatment for latent TB infection should be initiated if the chest X-ray is normal and there are no signs of active TB. If testing was done, please attach or enter results on next page.

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