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 Lic 702 2008-2023

Lic 702 2008-2023

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PHYSICAL/MEDICAL EXAMINATION DEVELOPMENTAL HISTORY (*For infants and preschool-age children only) WALKED AT BEGAN TALKING AT * MONTHS TOILET TRAINING STARTED AT * MONTHS * MONTHS PAST ILLNESSES — Check illnesses that child has had and specify approximate dates of illnesses: DATES DATES DATES ■ Chicken Pox ■ Diabetes ■ Poliomyelitis ■ Asthma ■ Epilepsy ■ ■ Rheumatic Fever ■ Ten-Day Measles (Rubeola) Whooping cough ■ ■ ■ Hay Fever Mumps Three-Day...
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