‘AdolescentWCC

_ here for well child check. No parental or patient concerns at this time.

RISK ASSESSMENT (non-confidential):
– Has never fainted before.
– No h/o cough, chest pain, or shortness of breath with exercise.
– Has never had a significant head injury.
– No family history of someone dying suddenly while exercising.
– No family history of MI or stroke before age 55.

RISK ASSESSMENT (confidential):
– Home: Safe, peaceful home environment. Family members all get along, more or less.
– Education/Employment: School is going _. No problems with safety or bullying at school.
– Eating: No concerns about body appearance. Getting sufficient calcium in diet (at least 4 servings per day). No dietary restrictions.
– Activities: Enjoys hanging out with friends. Screen time _. Is involved in _
– Drugs: No history of tobacco, EtOH, or drug use. No friends are using these substances.
– Safety: No history of violent relationships at home or elsewhere.
– Sex: Prefers _. Has not been sexually active (oral or genital) yet.
– Suicidality/Mental Health: No concerns. No history of physical or sexual abuse. Sleeps well at night.

PM/SH:
Normal pregnancy and delivery. No surgeries, hospitalizations, or serious illnesses to date.

OB/GYN HX:
Menses started at age _, and is regular.

SOCIAL:
– No smokers in the home.
– No TB or lead risk factors.
– Plans after high school: _

IMMUNIZATIONS:
– Up to date.