Foster Care Physical Health Assessment Form
Child Information
Full Name
Date of Birth
Gender
Current Caregiver Name
Caseworker
Assessment Details
Date of Assessment
Assessor Name
Location
Vital Signs
Height
Weight
BMI
Blood Pressure
Medical History
Medical History / Chronic Conditions
Current Medications
Known Allergies
Immunization Status
Immunization Records
General Physical Examination
General Appearance
Head / Eyes / Ears / Nose / Throat
Cardiac
Respiratory
Abdomen
Skin
Neurological
Other Findings
Assessment Summary & Recommendations
Summary
Recommendations / Referrals
Assessor Signature
Date