Pediatric Forms
Providing Information to Help You Care for Your Child
Sports Physicals For Kids: What to Expect
Patient Forms:
If your child is a new patient, you will be asked to complete the following packet:
New Patient Packet in English:
Initial History Questionnaire English
New Patient Packet in Spanish:
Initial History Questionnaire Spanish
Sports Physical Forms
PPE Health, physical, and medical forms
PPE – Supplement for Athletes with Disabilities
Special Olympics Medical Form Instructions
Well Child Visit Forms:
At your child's regular check-ups, you will be asked to fill out a questionnaire about your child's health. You can complete these forms in advance by downloading the appropriate questionnaire, filling it out and bringing the completed form to your child's appointment.
Newborn Visit English and Spanish:
Two Week Visit English and Spanish:
Two Month Visit English and Spanish:
Pediatric TB English and Spanish
ASQ-3 (2 Month Questionnaire Spanish)
Staying Healthy Assessment Spanish
4 Month Visit English and Spanish:
Pediatric TB English and Spanish
ASQ-3 (4 month Questionnaire in Spanish)
Staying Healthy Assessment-Spanish
6 Month Visit English and Spanish:
Pediatric TB English and Spanish
ASQ-3 (6 Month Questionnaire-Spanish)
Staying Healthy Assessment-Spanish
9 Month Visit English and Spanish:
Pediatric TB English and Spanish
ASQ-3 (7-12 Month Questionnaire)
ASQ-3 (7-12 Month Questionnaire-Spanish)
Staying Healthy Assessment-Spanish
12 Month Visit English and Spanish:
Pediatric TB English and Spanish
ASQ-3 (12 Month Questionnaire)
ASQ-3 (12 Month Questionnaire-Spanish)
Staying Healthy Assessment-Spanish
15 Month Visit English and Spanish
Pediatric TB English and Spanish
ASQ-3 (16 Month Questionnaire)
ASQ-3 (16 Month Questionnaire-Spanish)
Staying Healthy Assessment-Spanish
18 Month Visit English and Spanish:
Pediatric TB English and Spanish
ASQ-3 (18 Month Questionnaire)
ASQ-3 (18 Month Questionnaire-Spanish)
Staying Healthy Assessment-Spanish
2 Year Visit English and Spanish:
Pediatric TB English and Spanish
ASQ-3 (24 month Questionnaire)
ASQ-3 (24 Month Questionnaire-Spanish)
Staying Healthy Assessment-Spanish
2 ½ Year Visit English and Spanish:
Pediatric TB English and Spanish
ASQ-3 (30 month Questionnaire)
ASQ-3 (30 Month Questionnaire-Spanish)
Staying Healthy Assessment-Spanish
3 Year Visit English and Spanish:
Pediatric TB English and Spanish
ASQ-3 (36 month Questionnaire)
ASQ-3 (36 Month Questionnaire-Spanish)
Staying Healthy Assessment-Spanish
4 Year Visit English and Spanish:
Pediatric TB English and Spanish
ASQ-3 (48 Month Questionnaire)
ASQ-3 (48 Month Questionnaire-Spanish)
Staying Healthy Assessment-Spanish
5 - 8 Year Visit English and Spanish:
Pediatric TB English and Spanish
Staying Healthy Assessment-Spanish
9 - 11 Year Visit English and Spanish:
Pediatric TB English and Spanish
Staying Healthy Assessment-Spanish
12-17 Year Visit English and Spanish:
Staying Healthy Assessment-Spanish
Pediatrics Resources & Downloads:
An Open Letter from Your Pediatric Providers During COVID-19 - Download
Top Tips for Kids During COVID-19 by Karisma Ebora, CPNP-PC - Download
Team Spirit During Distance Learning by Janine Arbelaez, Psy.D, LMFT -
Download
RRH Podcasts on Children's Health:
Importance of Well Visits, Vaccinations, Physicals, Summer Safety
Featuring: Jennifer Prince, DO
Recognizing Flu Symptoms in Children
Featuring: Andrew Modic, MD
Type 1 Diabetes in Children - What is it and What to Look Out For Featuring: Jesse Allande, RN
Other Downloads:
Childhood Lead Poisoning Prevention (Kern County Public Health) -
Fact Sheet (English/Spanish)
Making Healthier Choices to Help Keep Your Child Safe From Lead (Kern County Public Health) - (English)
Making Your Home Lead Safe (Kern County Public Health) - (English)
Protect Your Child From Lead (Kern County Public Health) -(English/Spanish)
Useful Links
www.safekids.org/ - Think of us as your go-to source for safety information and safety tips. On this site, you will find tips from top safety experts on everything you need to keep kids of any age safe from preventable injuries.
-
Carmen C. Briones, MD
PediatricsView Profile
-
Kevin S. Flanigan, MD
Internal MedicineView Profile
-
Rabih K. Hamzeh, MD
PediatricsView Profile
-
Jixi . He, MD
PediatricsView Profile
-
Jurian F. Kaunang, MD
PediatricsView Profile
-
Andrew J. Modic, MD
Internal MedicineView Profile
-
Victoria B. Schauf, MD
PediatricsView Profile
-
Jane . Yoon, MD
PediatricsView Profile
-
Cheryl E. Zentner, MD
PediatricsView Profile
-
Karen E. Davin, CPNP-PC
PediatricsView Profile
-
Carolyn P. Lyon, PA
PediatricsView Profile
-
Jennifer . Prince, DO
-
RRH to suspend labor and delivery s ...
Featured, News
Notice of Elimination of Supplemental Service SUMMARY Due to significant financial and staffing challenges, Ridgecrest Regional Hospital expects that ...
Continue Reading -
RRH to suspend labor and delivery s ...
Featured, Blog
Notice of Elimination of Supplemental Service SUMMARY Due to significant financial and staffing challenges, Ridgecrest Regional Hospital expects that ...
Continue Reading -
Understanding Your Digestive ...
Blog
What's the Difference Between Crohn's and Colitis? Crohn's and colitis are two conditions that are often grouped together when we talk about causes, ...
Continue Reading -
Common Childhood Illnesses
Blog
6 Common Pediatric Conditions Childhood is often seen as a time when people are more vulnerable to getting sick because children's immune systems are ...
Continue Reading -
Finding connection — in February ...
Blog
With Valentine’s Day approaching, love is in the air! But love is always around us in our connections with one another. The Beatles captured the power ...
Continue Reading -
Living Life After Breast Cancer
Blog
Remission Advice for Breast Cancer Patients It's been a long road, but you've finally reached the end of your breast cancer treatment: you've got ...
Continue Reading -
How Common is Pneumonia?
Blog
What is Pneumonia? With the changing seasons, many of us focus on preventing the common cold and seasonal flu. However, we often forget one condition ...
Continue Reading -
Community – The Under-Sung Hero of ...
Blog
Wellness Article October 2023 When you think about Ridgecrest what first comes to mind? Of course, most people might say the wind or the heat but when ...
Continue Reading -
Benefits of Enlisting a Health ...
News
Many people have a desire to improve their health and wellness but aren’t quite sure how. If you want to create a wellness plan tailored to your ...
Continue Reading -
Strengthening Relationships Through ...
Blog
Celebrate Love and Wellness: Tips for Strengthening Your Relationship Valentine's Day is a time to celebrate love and affection with your significant ...
Continue Reading