Docstoc

My Baby’s Health Record

Document Sample
My Baby’s Health Record Powered By Docstoc
					Healthy Start, Grow Smart,

                    Smart,
      My Baby’s Health Record

     Building a Bright Future for
   Your 15- to 17-Month-Old Child
How To Use This Folder
Your baby depends on you to stay healthy. One of the ways to do this is
to make sure your baby has health insurance coverage. Keep copies of important
documents such as your baby’s birth certificate and Social Security card in the
back pocket of this folder. Original documents should be kept in a safe place
such as a fireproof box. You can take this folder with you to your baby’s health
care provider or to your local social welfare, health, or family services office to
see if you qualify for Medicaid or State Children’s Health Insurance Program
(SCHIP) services. You can also write down information about your baby’s
health, emergency numbers, and questions for your baby’s health care provider.
Use this folder to keep important documents in one place to make sure you
have everything you need to apply for health insurance coverage. You can also
keep track of your baby’s shot record here.
You will find many useful tips to keep your baby safe and help your baby grow
in the Healthy Start, Grow Smart booklet series. Ask your health care provider
about how to get your monthly booklets.
                                                          Reset All Forms
Information About My Baby 

Name:              ___________________________________________________

Born:              ___________________________________________________

                  [Hospital Name]
                   ___________________________________________________
                  [City, State]
                   _______________________   _________________________
                   [Date]                    [Time]
Delivered by:      ___________________________________________________
                  [Name of Doctor]
                   Weight_________________   Length ___________________

My Baby’s Health Care Provider:
Name: __________________________________________________________
Address:_________________________________________________________
Phone: __________________________________________________________

My Baby’s Dental Provider:
Name: __________________________________________________________
Address:_________________________________________________________
Phone: __________________________________________________________

Hospital Name:
Address:_________________________________________________________
Phone: __________________________________________________________

Pharmacy Name:
Address:_________________________________________________________
Phone: __________________________________________________________

Emergency Contact 1:
Phone: __________________________________________________________
Address:_________________________________________________________

Emergency Contact 2:
Phone: __________________________________________________________
Address:_________________________________________________________

Poison Control Hotline: 1–800–222–1222




My Baby’s Health Record                                               1
Paying for Your Baby’s Health Care:
Health Insurance
If your baby currently does not have health insurance, you can visit your
local social welfare, health, or family services office to learn more about
free or low-cost health insurance for children. You can also call the U.S.
Department of Health and Human Services Insure Kids Now Program
at 1–877–KIDS–NOW (1–877–543–7669) or visit their Web site at
www.insurekidsnow.gov. If you qualify for Medicaid, your baby can
get free checkups.
Your local social welfare, health, or family services office can tell you how
to apply for Medicaid services. To qualify for Medicaid services, your baby
has to be a U.S. citizen or have legal immigration papers. The parents’ legal
status is not taken into account. If your baby was born in the United States,
you can use the birth certificate to show your baby is a citizen. (The hospital
where your baby was born and/or your local social services office will be able
to assist you in getting a birth certificate for your baby.) If your baby was
not born in the United States, you will need the baby’s certificate of natural­
ization, certificate of citizenship, or legal immigration papers.

If you do not have any of these items, you will need two documents: one to
show your baby is a citizen and one to show who your baby is.
To show who your baby is you can bring any of the following:
n   A Report or Certification of Birth Abroad of a U.S. Citizen
    (Form FS-240 or FS-545).
n   U.S. Citizen I.D. card (DHS Form I-197).
n   Adoption papers.
n   Military Record if it shows where your baby was born.
n   American Indian Card (I-872).




2                                                         Healthy Start, Grow Smart
To show who your baby is you can bring:

n   Your baby’s picture on a state identity card.

n   A federal, state, or local government identification card.

n   A U.S. Military identification card. 

n   Native American tribal document.

If your baby is a citizen, but you do not have any of these documents, 

you should:
n   Tell Medicaid why you can’t get these documents.

n   Give Medicaid any documents that you do have.

Ask your local Medicaid office how much time you have to get the 

documents you need for your application. You can also ask how long
it will take to find out if you qualify. 

Make sure to put a copy of your important papers in the pocket of this 

folder so you will have them in the future.

To find out about health insurance programs for your baby in your state, call

1–877–KIDS–NOW (1–877–543–7669) or visit www.insurekidsnow.gov.



Finding a Health Care Provider
for Your Baby
If you do not know where to take your baby for care, call your local health
department or ask at a local hospital. You can also ask a close friend or
relative who has children about where their children receive health care.
Ask them if they really like the children’s health care provider and if the
provider takes time to explain things and answer questions.




My Baby’s Health Record                                                       3
My Baby’s Checkups
Use the space below to write information on each checkup.

First Checkup
Date: _____________     Weight: ___________      Length: ____________

Notes: _____________________________________________________

1-Month Checkup
Date: _____________     Weight: ___________      Length: ____________

Notes: _____________________________________________________

2-Month Checkup
Date: _____________     Weight: ___________      Length: ____________

Notes: _____________________________________________________

4-Month Checkup
Date: _____________     Weight: ___________      Length: ____________

Notes: _____________________________________________________

6-Month Checkup
Date: _____________     Weight: ___________      Length: ____________

Notes: _____________________________________________________

9-Month Checkup
Date: _____________     Weight: ___________      Length: ____________

Notes: _____________________________________________________

12-Month Checkup
Date: _____________     Weight: ___________      Length: ____________

Notes: _____________________________________________________




4                                                     Healthy Start, Grow Smart
My Baby’s Shots and Immunizations
Your baby’s first shot is given at birth. Your baby will get other shots
(immunizations) at the checkups. These shots protect your baby against
diseases such as hepatitis, polio, measles, mumps, and chicken pox.
Without the shots, your baby could get sick from one of these diseases.
It is good to know that health care providers are trained on how to give
shots in the most gentle way, but your baby may still cry. If you know your
baby will get a shot, you may want to bring a favorite toy or blanket to
comfort your baby. Also be sure to ask the health care provider what
reaction your baby might have from the shots.
Use the chart on the next page to write in the date of the checkup
when your baby receives each shot. This will help keep track of important
shots your baby needs. The chart shows the checkups when most babies
receive these shots. Your health care provider or clinic will give your
baby the shots needed at each age. While your baby may not receive
every shot listed in this table, you should discuss this with your health
care provider.
Protect your baby from disease. Shots help your baby—and the
community—stay healthy. A lot of research has been done to make
sure the shots are safe. If you have questions, talk to your baby’s health care
provider.
Get the facts!




My Baby’s Health Record                                                       5
My Baby’s Shots and Immunizations
You can use the chart to write in the dates when your baby receives each shot.


 Important Shots           3 to 5   2-Month   4-Month    6-Month      12-Month
 (Immunizations)           Days     Checkup   Checkup    Checkup      Checkup

 Hepatitis B (Hep B)


 Rotavirus (Rota)


 Diphtheria, Tetanus,
 Pertussis (DTaP)


 Haemophilus
 influenzae type b (Hib)


 Pneumococcal
 Conjugate Vaccine (PCV)


 Inactivated Poliovirus
 (IPV)


 Influenza


 Measles, Mumps,
 Rubella (MMR)


 Varicella


 Hepatitis A (Hep A)




6                                                         Healthy Start, Grow Smart
List of My Baby’s “Firsts”
Use the space below to write down the date for each of your baby’s “firsts.”
Your baby’s health care provider may ask you about some of these during
checkups to follow up on how your baby is developing.

My Baby’s First…                                            Date


My baby first smiled on:                                    ____________

My baby first rolled over on:                               ____________

My baby first sat up on:                                    ____________

My baby first crawled on:                                   ____________

My baby first stood up with someone’s help on:              ____________

My baby’s first words said on:                              ____________

My baby first walked on:                                    ____________

My baby first ate solid food on:                            ____________

My baby’s first tooth showed on:                            ____________




My Baby’s Health Record                                                        7
Times When My Baby Has Not Been Well

Use the space below to record any serious problems or sicknesses your baby
has and when they happen. This information can be very helpful in treating
your baby and identifying serious problems now or in the future.

Problem or sickness                          Date started - Date ended
___________________________                  _________         ________
_____________________________________________________
_____________________________________________________


___________________________                  _________         ________
_____________________________________________________
_____________________________________________________


___________________________                  _________         ________
_____________________________________________________
_____________________________________________________


___________________________                  _________         ________
_____________________________________________________
_____________________________________________________


___________________________                  _________         ________
_____________________________________________________
_____________________________________________________




8                                                      Healthy Start, Grow Smart
Where To Find Help
You are not alone. There are many organizations that can help you keep
your baby healthy and safe. They are there to provide support to all parents.
Health Insurance: If you are eligible for Medicaid, your baby can get
free checkups. You can call your local social welfare, health, or family
services office to see if you qualify for Medicaid or State Children’s Health
Insurance Program (SCHIP) services. To learn more about free or low-cost
health insurance for children, you can call the U.S. Department of Health
and Human Services Insure Kids Now Program at 1–877–KIDS–NOW
(1–877–543–7669). You can also visit their Web site
at www.insurekidsnow.gov.
Oral Health: To find a dentist working in your community, contact the
American Academy of Pediatric Dentistry at 1–800–544–2174, or go to
www.aapd.org/finddentist. You can also contact the American Dental
Association at 1–800–947–4746 or go to www.ada.org/public/disclaimer.asp.
Lead Poisoning: For information about lead hazards and lead poisoning
prevention, and for a list of state-certified (licensed) lead professionals for
lead evaluation services, contact the National Lead Information Center. Call
1–800–424–5323 or go to www.epa.gov/lead.
Food and Nutrition/WIC: Families who are enrolled in the WIC
program (Special Supplemental Nutrition Program for Women, Infants,
and Children) can get information on breastfeeding, formula feeding, and
nutrition at their local WIC office. Families eligible for WIC receive
nutrition counseling and supplemental foods such as baby formula, milk,
and cereal. To find the WIC office nearest you, call your state health
department or visit the WIC Web site at www.fns.usda.gov/wic.
Breastfeeding: To learn more about breastfeeding, call La Leche League at
1–800–LALECHE (1–800–525–3243) or visit www.lalecheleague.org.
Poison Control: The American Association of Poison Control Centers
(AAPCC) poison control hotline, 1–800–222–1222, should be on your list
of emergency numbers. To learn more, you can visit the AAPCC Web site
at www.aapcc.org.




My Baby’s Health Record                                                       9
Car Seats: For information on resources that help families purchase or
borrow child car seats, call the National Highway Traffic Safety
Administration at 1–800–424–9393 or visit www.nhtsa.dot.gov. Always
test the seat to make sure it is installed correctly.
Safety: To learn more about safety, call the Consumer Product Safety
Commission at 1–800–638–2772 or visit www.cpsc.gov.
Postpartum Depression: For more information and resources on
postpartum depression, breastfeeding, and many other women’s health
issues, call The National Women’s Health Information Center at
1–800–994–9662 or visit www.womenshealth.gov.
Emergency Planning: For disaster relief services and lifesaving courses,
contact the American Red Cross. To find your local American Red Cross
chapter, call 1–800–435–7669, or go to www.redcross.org/where/where.html.
Child Abuse—Preventing and Helping: For information on how to prevent
or stop child abuse—or for help in a crisis, you can contact the Childhelp
USA National Abuse Hotline. Call 1–800–422–4453, or go to
www.childhelpusa.org/report_hotline.htm.
Education: For information about early childhood education programs,
call the Department of Education at 1–800–USA–LEARN or visit
www.ed.gov/parents/earlychild/ready/resources.html.
Child Care: To learn about child care options, call the Department of
Health and Human Services, Child Care Aware at 1–800–424–2246 or visit
www.childcareaware.org.
Disabilities: For information on disabilities and related issues for families,
call the National Dissemination Center for Children with Disabilities at
1–800–695–0285 or visit www.nichcy.org.


Remember to also take time for yourself. Your baby will be happier with
happy parents. Try to do healthy things that make you feel good!




10                                                         Healthy Start, Grow Smart
Notes
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________




My Baby’s Health Record                                    11
Notes

_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________




12                                           Healthy Start, Grow Smart
How To Use This Folder
Use the Healthy Start, Grow Smart, My Baby’s Health Record to file impor­
tant health information about your baby. Take it with you to appointments
so you can share information with your baby’s health care provider or clinic.
It can help you keep your baby’s medical records and other papers safe—
and make it easier to save instructions and medical advice.
Acknowledgments

This publication is distributed by the U.S. Department
of Health and Human Services, and is in the public
domain. Authorization to reproduce it in whole or
in part is granted. While permission to reprint this
publication is not necessary, the citation should be:
U.S. Department of Health and Human Services,
Centers for Medicare & Medicaid Services. Healthy
Start, Grow Smart, My Baby’s Health Record, Baltimore,
MD: U.S. Department of Health and Human Services,
Centers for Medicare & Medicaid Services.
This publication is available to download on the U.S.
Department of Education’s Web site at:
www.ed.gov/parents/earlychild/ready/healthystart/
index.html. It is also available in Spanish on the
Department of Education’s Web site.
On request, this publication is available in alternate
formats, such as Braille, large print, audiotape, or
computer diskette. For more information, please
contact the Department’s Alternate Format Center
202–260–0852 or 202–260–0818.
This publication can also be downloaded at the
U.S. Department of Health and Human Services,
Centers for Medicare & Medicaid Services Web site
at: www.cms.hhs.gov/LowCostHealthInsFamChild/
03_HSGSPamphlets.asp or cms.ntis.gov.

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:31
posted:7/14/2010
language:English
pages:16