Child Health Clinical Record Forms

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Use links below to download Child Health Clinical Record Forms. These forms are intended for use as a documentation tool for all required checkup components and should never be given out as a client questionnaire. Instructions are also available. The forms are recommended for your use by Texas Health Steps; they are not required.

The Portable Document Format (PDF) forms include form fill fields (for example; text fields, check boxes) so that you can complete them online using an Acrobat product such as Adobe Reader, Acrobat 3D, Acrobat Professional, or Acrobat Standard. Link to File Viewing Information located in the bottom tool bar of this web page for information on downloading Adobe Reader.

All Child Health Clinical Record Forms have been revised due to Texas Health Steps policy updates effective December 1, 2011

All Child Health Clinical Record Forms have been updated February 2012

Instructions for Child Health Clinical Record Forms [PDF 4,397KB]

Child Health History Form ECHR-1 [PDF 1,364KB]

Child Health Clinical Record Forms
ECHR-5 Day [PDF 890KB]
ECHR-2 Week [PDF 880KB]
ECHR-2 Month [PDF 882KB]
ECHR-4 Month [PDF 999KB]
ECHR-6 Month [PDF 1,024KB]
ECHR-9 Month [PDF 914KB]
ECHR-12 Month [PDF 925KB]
ECHR-15 Month [PDF 1,261KB]
ECHR-18 Month [PDF 923KB]
ECHR-24 Month [PDF 1,041KB]
ECHR-30 Month [PDF 910KB]
ECHR-3 Year [PDF 942KB]
ECHR-4 Year [PDF 81,071KB]
ECHR-5 Year [PDF 1,082KB]
ECHR-6 Year [PDF 1,071KB]
ECHR-7 Year [PDF 896KB]
ECHR-8 Year [PDF 894KB]
ECHR-9 Year [PDF 895KB]
ECHR-10 Year [PDF 892KB]
ECHR-11 Year [PDF 894KB]
ECHR-12 Year [PDF 893KB]
ECHR-13 Year [PDF 892KB]
ECHR-14 Year [PDF 897KB]
ECHR-15 Year [PDF 896KB]
ECHR-16 Year [PDF 898KB]
ECHR-17 Year [PDF 897KB]
ECHR-18 Year [PDF 896KB]
ECHR-19 Year [PDF 898KB]
ECHR-20 Year [PDF 896KB]
ECHR-19-20 Year [PDF 896KB]

Última actualización 21 de marzo de 2012