COVID Screening and Medical History Update 2020

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Medical History Update

First Child:

In the last six months has your child had any changes in medical history, including recent hospitalizations, surgeries, or new food or drug allergies?YesNo

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Second Child:

In the last six months has your child had any changes in medical history, including recent hospitalizations, surgeries, or new food or drug allergies?YesNo

Add another child to this appointment

Third Child:

In the last six months has your child had any changes in medical history, including recent hospitalizations, surgeries, or new food or drug allergies?YesNo

Add another child to this appointment

Fourth Child:

In the last six months has your child had any changes in medical history, including recent hospitalizations, surgeries, or new food or drug allergies?YesNo

Add another child to this appointment

Fifth Child:

In the last six months has your child had any changes in medical history, including recent hospitalizations, surgeries, or new food or drug allergies?YesNo

Add another child to this appointment

Sixth Child:

In the last six months has your child had any changes in medical history, including recent hospitalizations, surgeries, or new food or drug allergies?YesNo