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1 Immunization Records childrens.memorialhermann.org CARE /13

2 Personal Health Record of The Woodlands Contact Information Date and time of birth Place of birth Pediatrician name, phone number Katy Sugar Land 290 City 10 Southwest Northwest 8 Children s 288 Texas Medical Center Northeast Southeast 6 45 Additional doctor name, phone number Additional doctor name, phone number

3 Hospital Listings Children s Hospital KIDS (5437) Katy City Northeast Northwest Southeast Southwest Sugar Land The Woodlands Statistical Information to be completed by a parent Sex Gestation Delivery (Normal/Cesarean) Complications of birth/infancy Allergies/sensitivities Notes

4 Additional information and footnote references available at Recommended Immunization Schedule 0-6 Years U.S. Age Birth Vaccine mo. mos. mos. mos. mos. mos. mos. mos. years years Hepatitis B 1 HepB HepB HepB HepB Series Rotavirus 2 Rota Rota Rota Diphtheria, Tetanus, Pertussis 3 DTaP DTaP DTaP DTaP DTaP Haemophilus Hib Hib Hib 4 Hib Hib influenzae type b 4 Pneumococcal 5 PCV PCV PCV PCV PPV Inactivated Poliovirus IPV IPV IPV IPV Influenza 6 Influenza (Yearly) Measles, Mumps, MMR MMR Rubella 7 Varicella 8 Varicella Varicella Hepatitis A 9 HepA Series (2 doses) HepA Series Meningococcal 10 MCV4 Range of recommended ages Catch-up immunization certain high-risk groups Body Mass Index (BMI) Is your child overweight or obese? There are a number of different things you can do to make sure your child is at a healthy weight. Annual well visits with your child s doctor are very important, giving the doctor the opportunity to monitor and record your child s changing weight and height. Having this history will enable the doctor to spot any possible problems and to discuss them with you. If you feel your child is at risk, don t hesitate to ask your doctor to evaluate his or her weight and height. One key indicator of a problem is the Body Mass Index or BMI. If your child is over 2 years of age and his or her BMI is in the 85th percentile, this means your child is heavier than 85 percent of children the same height and age, and could be overweight or at risk of becoming obese. A child over 2 years of age in the 95th percentile is defined as having childhood or adolescent obesity.

5 Hearing Checklist for Your Infant Additional information and footnote references available at Infants hear and listen from the moment of birth. Good hearing is essential for your baby to learn to talk. Is your baby on track? 0-3 months Startles at sudden, loud sounds Recognizes your voice and quiets when you speak 3-6 months Turns eyes toward interesting sounds Appears to listen 6-9 months Understands No and Bye-Bye Begins to imitate speech sounds 12 months Says first words such as Ma-Ma or Bye-Bye If you suspect that your child has a hearing problem, don t wait to seek help. Call today. The Center for Hearing and Speech voice/ TTY Recommended Immunization Schedule 7-18 Years U.S. 15 years years years 7-10 years Tdap Tdap HPV (3 doses) HPV Series MCV4 MCV4 PPV Influenza (Yearly) MCV4 Age Vaccine Tetanus, Diphtheria Pertussis 1 Human Papillomavirus 2 Meningococcal 3 Pneumococcal 4 Influenza 5 Hepatitis A 6 Hepatitis B 7 Inactivated Poliovirus 8 Measles, Mumps, Rubella 9 Varicella 10 HepA Series HepB Series IPV Series MMR Series Varicella Series Catch-up immunization certain high-risk groups Range of recommended ages

6 Immunization Record Take this record with you each time your child visits the doctor. Foot Print or Palm Print Right Date Vaccine Physician/Provider Date Age

7 Foot Print or Palm Print Left Immunization Record Take this record with you each time your child visits the doctor. Date Vaccine Physician/Provider Date Age

8 Immunization Record Take this record with you each time your child visits the doctor. Date Vaccine Physician/Provider Growth Chart Age Date Weight Height Head Birth This is your child s personal record of vaccinations received for protection against various diseases, to be presented to your child s healthcare providers at well-child and other medical visits. Always consult your pediatrician or primary care physician when making immunization and other health decisions.

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