{"content":[{"text":"31/2 - 4 YEAR OLD HEALTH ASSESSMENT","bbox":{"left":0.204025,"top":0.043515,"width":0.591977,"height":0.023674}},{"text":"Date: ………/…………/…………..","bbox":{"left":0.095259,"top":0.083552,"width":0.31425000000000003,"height":0.021517999999999995}},{"text":"Parent / Guardian - Please complete questionnaire about your child \n prior to seeing doctor","bbox":{"left":0.095259,"top":0.119182,"width":0.656483,"height":0.040615000000000026}},{"text":"Child’s Name:","bbox":{"left":0.095259,"top":0.191955,"width":0.124875,"height":0.01578299999999999}},{"text":"Past Medical History \n □ \n Birth Term \n □ \n Pre-term …….. Weeks \n □ \n Low weight at birth Yes \n □ \n No \n □ \n Normal vaginal delivery \n □ \n Caesarean \n Past Medical Conditions \n ……………………………………………… \n ………………………………………………","bbox":{"left":0.509156,"top":0.191955,"width":0.36289099999999996,"height":0.195855}},{"text":"………………………………………………..","bbox":{"left":0.095259,"top":0.224734,"width":0.372971,"height":0.01578299999999999}},{"text":"D.O.B………………………………………...","bbox":{"left":0.095259,"top":0.257371,"width":0.371258,"height":0.01578299999999999}},{"text":"Address: ……………………………………..","bbox":{"left":0.095259,"top":0.29015,"width":0.37468500000000005,"height":0.01578299999999999}},{"text":"………………………………………","bbox":{"left":0.170861,"top":0.322929,"width":0.30240899999999993,"height":0.01578299999999999}},{"text":"………………………………………","bbox":{"left":0.170861,"top":0.355637,"width":0.30240899999999993,"height":0.01578299999999999}},{"text":"Email:","bbox":{"left":0.095259,"top":0.388416,"width":0.05830500000000001,"height":0.01578299999999999}},{"text":"……………………………………..","bbox":{"left":0.173784,"top":0.388416,"width":0.292238,"height":0.01578299999999999}},{"text":"Past Surgical Procedures \n ……………………………………………… \n ……………………………………………… \n Congenital Conditions \n ……………………………………………… \n ……………………………………………… \n Past Injuries (e.g. falls, head injuries) \n ……………………………………………… \n ………………………………………………","bbox":{"left":0.509156,"top":0.404948,"width":0.36289099999999996,"height":0.14675700000000003}},{"text":"Next of Kin:-","bbox":{"left":0.095259,"top":0.421338,"width":0.113131,"height":0.01578299999999999}},{"text":"Mother: ……………………………………..","bbox":{"left":0.095259,"top":0.453974,"width":0.37409000000000003,"height":0.01578299999999999}},{"text":"Father: ……………………………………..","bbox":{"left":0.095259,"top":0.486753,"width":0.37237600000000004,"height":0.01578299999999999}},{"text":"Siblings: …………………………Age: …….","bbox":{"left":0.095259,"top":0.519532,"width":0.376412,"height":0.01578299999999999}},{"text":"……………………………Age: …….","bbox":{"left":0.160781,"top":0.552311,"width":0.311396,"height":0.01578299999999999}},{"text":"Medication \n Short term ………………………….. \n Long term ……………………………","bbox":{"left":0.509156,"top":0.568844,"width":0.341622,"height":0.04841899999999999}},{"text":"……………………………Age: …....","bbox":{"left":0.165821,"top":0.58509,"width":0.306361,"height":0.01578299999999999}},{"text":"………………………….…Age: ..…..","bbox":{"left":0.160781,"top":0.61787,"width":0.311403,"height":0.01578299999999999}},{"text":"Allergies \n ……………………………………………… \n ………………………………………………","bbox":{"left":0.509156,"top":0.634402,"width":0.36289099999999996,"height":0.04841899999999999}},{"text":"Paediatrician ………………………………","bbox":{"left":0.509156,"top":0.699817,"width":0.362286,"height":0.01578299999999999}},{"text":"Consent for Health assessment: (Parent to sign) …………………………………","bbox":{"left":0.095259,"top":0.785442,"width":0.8001690000000001,"height":0.018387000000000042}},{"text":"Completed by:","bbox":{"left":0.095259,"top":0.823422,"width":0.139094,"height":0.018387000000000042}},{"text":"(Nurse to sign)","bbox":{"left":0.36956,"top":0.823422,"width":0.14107599999999998,"height":0.018387000000000042}},{"text":"…………………………………….","bbox":{"left":0.540093,"top":0.823422,"width":0.335048,"height":0.018387000000000042}},{"text":"Assessment reviewed by:","bbox":{"left":0.095259,"top":0.861687,"width":0.238877,"height":0.018387000000000042}},{"text":"(Doctor to sign) ………………………….…………","bbox":{"left":0.36937,"top":0.861687,"width":0.503291,"height":0.018387000000000042}}],"images_bbox":[],"images_bbox_not_text_overlap":[]}