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Health Care Visit and Illness Record

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Use this chart to keep track of your child's visits to doctors or other health care providers. Also use this chart to keep track of your child's illnesses (such as chicken pox, measles, or mumps) and injuries (such as broken bones). A record of childhood illnesses and injuries will be useful when your child is an adult.

Date Illness/Reason for Visit Treatment/Medication




















































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KidSource OnLine KidSource OnLine is a registered trademark of Kidsource OnLine, Inc. Copyright 2008. Other trademarks property of their respective holders. Created: April 23, 1996 . Last modified: June 30, 1997 .