SIX-MONTHLYHEALTHASSESSMENTFORPRE-SCHOOL AGE CHILDREN IN CARE

Today’s Date: / Accompanied by:
Name: / Date of Birth:
Current Address:
Telephone Number:
Name of Present Carer:
Social Worker:
Telephone Number: / Legal Status:
Consent for health assessment in Looked After documents?
Nursery/Playgroup:
GP: / Dentist:
Date of last Appointment:
Immunisation status:
Is child fully immunized for age? / Diphtheria
Tetanus
Polio
Pertussis / HIB / Men C / MMR / PCV / Other
(please specify)
Illness/Health Appointments/Hospital Admissions In Last 6 Months: / Health Professionals Currently Involved:
Current Medication:
Height:
Centile: / Weight:
Centile: / BMI:
Allergies:
Today’s Date: / Accompanied: /

Yes/No

/ By Whom:
Name: / Date of Birth:
Current Address:
Telephone Number:
GP: / Dentist:
Date of last appointment:
Social Worker:
Telephone No: / Carer:
Telephone No:
Nursery: / Legal Status:
Immunisation status
Is child fully immunized for their age? / PVC / Diphtheria / Tetanus / Pertussis / Polio / HIB / Men C
Other:
Height: / Centile: / Weight: / Centile:
Other Health Professionals Currently Involved:
Illnesses/Hospitalisation/Health appointments (within previous 6 months):
Current Medication:
Name of Child D.o.b
Physical Health:
What toys and activities does the child enjoy?
Developmental milestones Fine and Gross Motor Skills: (date & results of any formal developmental assessments)
Developmental milestones
Speech and Communication Skills:(date and results of any formal assessments)
Hearing:
Vision:
Nutrition:
Personal Safety:
Progress at Nursery/Playgroup(if applicable):
Continence/Constipation:
Sleep and Routine:
Name of Child D.o.b

Behaviour:

Emotional Health/Relationships:
Additional Comments:
Signature of Health Professional completing Assessment:
Print Name:
Designation:
Date:
Signature of Designated Doctor or Specialist Nurse for Children In Care:
Print Name:
Date:

Additional Information (if any)

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PART 2

HEALTH REPORT FOR CHILD IN CARE UNDER 10 YEARS

Name of Child D.o.b

To be shared with Social Worker, Reviewing Officer and Health professionals with permission of the young person if applicable.

Date of Health Assessment:-
Summary of Present physical/emotional health:-
Registered with GP
Name of GP:- / Yes/No
Registered with Dentist
Name of Dentist:- / Yes/No / Last Seen:-
Immunisations Up to Date? / Yes/No / Immunisations needed or due within next year:-
Next Health Assessment Due:-
Signed by professional:-
Print Name:-
Designation:-
Date:-

INDIVIDUAL HEALTHCARE PLAN FOR CHILDREN IN CARE

Name: / Date of birth:
Address: / School
Date of Health Assessment: / Date of Next Health Assessment:
Health Need: / Action to be Taken: / Person Responsible: / By When:
1.
2.
3.
4.
Signed by Professional Completing Plan:
Print Name:
Designation: Date:
Cc. Designated Doctor, GP, School Nurse, Health visitor, Reviewing Officer, Social Worker, Carer, Young Person

Social Worker: Please inform Community Nurse for Children in Care as soon as issues highlighted have been addressed