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Initial history intake link
Health maintenance Initial3 Final 3Cont. 3
Urgent care/Progress note Initialf Final
Immunization record link
Immunization record for nurse link
Developmental screen
Patient instruction
Physician order form
Return to school or work
Request copy health information link
Lab request
Lab test result notification link
VFC patient eligibility
Medical Record Request link
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ADHD management link
ADHD assessment/medications link
Allergy action plan- food link
Asthma action plan
Birth control link
IDPH Dental Exam Form link En Español
IDPH Eye exam Report Form link
IDPH Lead risk assessment link En Español
IDPH Lead high-risk ZIP Codes Link
School PE- IL Child link
Childcare PE- IL Child link
Sport PE - IHSA link
TB risk screen
WIC form
WIC formula/nutritional prescriptions
WIC formula resource listing Link |
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NB-1month old
2 months old
4 months old
6 months old
9 months old
12 months old
15 months old
18 months old
2-3 years old
4-5 years old
6-7 years old
8-11years old
12-14 years old
Well adolescent visit |
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CDC Growth Charts |
Boys 0-36mo Lt & Wt for age link
Boys 0-36mo HC for age link
Boys 2-20yrs Ht & Wt for age link
Boys 2-20yrs BMI fro age link
Girls 0-36mo Lt & Wt for age link
Girls 0-36mo HC for age link
Girls 2-20yrs Ht & Wt for age link
Girls 2-20yrs BMI for age link
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Referral Center
General referral form
Audiological evaluation
Developmental and rehabilitative
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| Immunization |
Vaccine record form for children link
Vaccine record form for adults link
Vaccination records from CDC link |
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| Test request and notification |
Allergy test -in vitro (RAST)
Consents for surgical procedures
Cytopathology request
Echo
EEG
Radiology - General
Radiology - CT
Radiology - MRI
Radiology Breast
Sleep study
Sweat test |
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