Pediatric Well-Child Visit Note Template

The well-child visit has a fixed list of expected components, and the list changes with the child's age. This two-page template follows the Bright Futures and AAP periodicity schedule. Page one covers interval history, growth with percentiles for length or height, weight, head circumference and BMI, blood pressure, and vision and hearing screening. Page two carries a surveillance and screening table, the physical exam and labs, immunizations, anticipatory guidance, and the coding block.

The screening table is the part that protects the claim. It lists each screen against its recommended ages, developmental screening at 9, 18 and 30 months, autism screening at 18 and 24 months, maternal depression at 1, 2, 4 and 6 months, behavioral and social-emotional screening at every visit, and depression and suicide risk screening from 12 through 21 years, then asks you to name the instrument and record the score. That matters because a non-standardized screen is not separately reportable unless the payer allows it. The page also prints the three things payers check: the age on the date of service picks the preventive code, every screening needs the tool named and the result recorded, and immunization administration is counted per component rather than per injection. Optimized for use with Sully.ai's AI medical scribe, it helps streamline note-taking and improve clinical efficiency.