Middle Adolescence Visit Name:____________________
Date Of Visit:____________________
Weight:____________________
Height:____________________
Things your doctor will do at today’s visit: - Ask for an update on your health
- Do a physical exam, including checking for scoliosis and signs of puberty
- Check your blood pressure and possibly your hearing and/or vision
- Show you how to do a testicular self-exam or breast self-exam
- If you are sexually active, you may be checked for sexually transmitted diseases (STDs). Females may need to have a pelvic exam.
- Ask about your family’s history of heart disease and test cholesterol levels if indicated
- Ask about possible exposure to tuberculosis (TB) and test you if indicated
- Discuss your risk of anemia (iron-poor blood) and test for it if indicated
- Make sure your immunizations are up to date, including tetanus (Td); hepatitis B; chicken pox; and measles, mumps, rubella (MMR). Your doctor may also recommend a meningococcal vaccine.
- Give you and your parent(s) an opportunity to ask questions
Things you may want to discuss at this visit: - Questions about dating and sex
- Dealing with anger, stress, sadness or depression
- How you feel about your body
- Concerns about tobacco, alcohol or drugs
- Any other concerns you have
Things your parent(s) may want to discuss at this visit: - Your growth
- Your diet (nutrition)
- Questions about development, puberty or sex
- Your sleeping habits
- Questions about behavior, discipline, tobacco, alcohol or drug use
- How you are doing in school
- Your interests, talents and after-school activities
Things for you to keep in mind: - Limit television, video watching and video games to one to two hours per day.
- Use sunscreen and do not visit tanning salons.
- Always use a seat belt, bike helmet and other protective sports gear.
- Do not use tobacco, alcohol or drugs.
- Do not use guns or other weapons.
- Learn how to protect yourself from physical, emotional and sexual abuse.
- Learn how to deal with anger and resolve conflicts.
- Trust your own feelings, but also listen to the advice of good friends and respected adults.
- Make healthy choices for meals and snacks, including plenty of fruits and vegetables; breads, cereals and other whole-grain products; low-fat, calcium-rich dairy products; and lean, iron-rich meats.
- Ask questions of trusted adults and learn about sex, birth control and STDs.
- If you are having sex, talk with your doctor about necessary exams and ways to protect yourself against pregnancy and disease.
- Respect your parents’ limits and rules, including the consequences for unacceptable behavior.
- Respect the rights and needs of others.
- Discuss with a trusted adult any feelings of frustration with school or thoughts of dropping out.
- Make plans for after high school, such as going to school, getting a job or taking time off. Think about what interests you most and what skills you would like to improve.
Schedule an appointment for your next visit, usually in one year. Date:_________________________
Time:_________________________ Based on health supervision guidelines from the American Academy of Pediatrics and from Bright Futures, which is funded by the U.S. Department of Health and Human Services, under the direction of the Maternal and Child Health Bureau. Last updated September 6, 2011. |
