iographic Data: Include the child's name, nickname, address and phone number,

parents' names and work numbers, child's age and birth date, birthplace, sex, race, ethnic

origin, and information about other children and family members at home.

• Source of History: 1. Person providing information and relation to child

2. Your impression of reliability of information 3. Any special circumstances (e.g., the

use of an interpreter)

• Reason for Seeking Care: Record the parent's spontaneou...
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