Well Child Visits

  • 3-5 day visit

  • 1 Month Visit

  • 2 Month Visit

  • 4 Month Visit

  • 6 Month Visit

  • 9 Month Visit

  • 12 Month Visit

  • 15 Month Visit

  • 18 Month Visit

  • 24 Month Visit

  • 30 Month Visit

  • 36 Month Visit

Child Health and Enrollment Information Form

  • Is the form complete? (No Blanks)

  • Is the form signed by the parent in both boxes?

  • Does the form indicate the child has any health or medical conditions?

  • Has the form been updated annually?

  • Has the administrator or a designee signed the form?

Child Medical/Physical Care Plan

  • Is the form complete? (No blanks)

  • Is the form signed and dated by a trainer (parent/guardian, certified professional)

  • Have all childcare staff members who work with the child been trained and signed the form?

  • Has the parent signed and dated the form?

  • Has the administrator signed and dated the form?

Medication Form

  • Has box 1 been completed, signed and dated by the parent/guardian? (No blanks)

  • If box 2 is applicable, has it been completed, dated, and signed by a licensed physician/dentist/advance practice nurse?

  • If box 3 is applicable, has it been completed correctly each time the medication has been administered?

Newborn Assessment (Only applicable if child is less than 6 months old on date of entry)

  • Is the assessment in the folder?

  • Does the assessment include the newborn hearing screening?

Peach Nutrition Assessment (Due within 45 days from date of entry and at 6 month intervals after initial screening)

  • Was the screening completed within 45 days from the date of entry?

  • Has the screening been updated every 6 months?

  • Are all questions on the screening complete (no blanks)

  • If the score was 4 points or above, there is documentation that the child has been referred to a registered dietician.

Immunization Records

  • Are immunizations up to date for age?

Parent Agreement for Screenings (Updated Annually)

  • Initial Parent Agreement was completed before screenings

  • Parent Agreement has been updated annually

Vision Screening Questionnaire

  • Newborn

  • 3-5 days

  • 1 Month

  • 2 Month

  • 4 Month

  • 6 Month

  • 9 Month

  • 12 Month

  • 15 Month

  • 18 Month

  • 24 Months

  • 30 Months

  • Vision Screening with Acuity-36 Months

  • If one or more risk factors have been identified, a copy of the vision screening questionnaire is shared with the family to discuss with the pediatrician.

  • If one or more behavioral signs have been identified, a copy of the Vision Screening Questionnaire was shared with the family to discuss with the pediatrician and there is documentation of a referral to a pediatric eye doctor.

Hearing Screening Questionairre

  • Newborn

  • 3-5 days

  • 1 Month

  • 2 Months

  • 4 Months

  • 6 Months

  • 9 Months

  • 12 Months

  • 15 Months

  • 18 Months

  • 24 Months

  • 30 Months

  • Hearing Screening with Results for Each Ear (36 Months)

  • If any screening shows risk factors or milestone indicators, an OAE screening has been conducted and results are documented in the folder.

  • If the OAE screening was completed and the child failed in either or both ears, documentation of a referral and follow-up is in the child's folder.

Speech Screening (PLS-5) (Due within 45 days from date of entry and at 6 month intervals after initial screening)

  • Screening was completed within 45 days of date of entry

  • If the screening showed a concern, there is documentation of a referral and follow-up in the child's folder.

  • Has the screening been updated every 6 months?

Sickle Cell Results

  • Results are in the file if applicable

  • If applicable, a referral has been made if the child tested positive and follow-up is documented in the child's folder.

Hemoglobin Results

  • If the child is 7 months or older, a hemoglobin result is on file.

  • If the hemoglobin result is lower than 11.2, a referral and documentation of follow-up in in the child's folder.

Lead Results

  • Proof of a lead screening at 12 months of age is in the child's file.

  • Proof of a lead screening at 24 months of age is in the child's file.

  • If a lead result is 10 or above (considered abnormal), there is a referral and follow-up documented in the child's file.

Dental Screening

  • A dental screening has been completed before the child transitions to preschool.

  • If a child's dental screening requires follow-up, there is documentation of dental follow-up in the child's file.

Child Health Record

  • There is a completed Child Health Record (no blanks) in the child's file.

  • The Child Health Record has been updated in January, May and September (3 times per year)

  • If there is a concern on the Child Health Record, referral and follow-up is documented in the child's file.

Growth Chart

  • Growth charts are updated in the child's file 3 times a year- January, May and September

  • If the growth chart (BMI) indicates that a child is underweight, overweight, or obese, there is documentation of referral and follow-up, as well as parent education in the child's file.

Child Observation Reports

  • If applicable, Child Observation Forms are complete (no blanks) and filled out correctly.

Child Incident Reports

  • If applicable, Child Incident Reports are complete (no blanks) and filled out correctly.

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