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DOCTOR: FIVE YEAR OLD VISIT
WEIGHT:
DATE:
HEIGHT:
lbs. oz. Blood Lead risk assessment
ins. Tuberculosis risk assessment
Visual Acuity
Audiogram
INFORMATION FOR THE DOCTOR:
QUESTIONS/PROBLEMS:
NOTES:
Safety Tips: Please read the following sections in this booklet.
Section VIII-0. Pedestrian Safety
Section Vill-N. Firearm Safety
Section Vlll-K. Water Safety
Your next appointment for a physical is when your child is six years old.
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