Iowa Child Health & Development Record

Iowa Child Health and Development Record

Iowa Child Health and Development Record (CHDR) forms are used to guide and document a child's health maintenance visits during the period from birth up to age 18. These notes include developmental milestones and potential red flags for referral and are based on the Iowa EPDST Care for Kids Health Maintenance Recommendations (Iowa Periodicity Schedule).

Iowa CHDR Forms

The Iowa CHDR forms help identify:

  • Risk factors in a child's life, such as nutrition concerns or family stressors; and
  • Developmental "red flags" that signal the need for further assessment and evaluation of delay or potential for delay.


Iowa Child Health and Development Record were developed with assistance and input from the:

Age-appropriate Forms

Each age-appropriate Iowa CHDR form provides:

  • An easy-to-use screening checklist with space for notes and comments to help you identify emerging concerns;
  • Screening components, including:
    • Health care
    • Developmental milestones and potential red flags
    • Parental risk factors that signal the need for intervention
    • Nutrition
    • Medications
    • Immunizations
    • Lead screening
  • Space to note parental input about a child's development (parents are often the first to detect delay);
  • Anticipatory guidance information;
  • Referral resources; and
  • A place to note the comprehensive health care plan and follow-up orders for the child.

Iowa CDHR Forms

Click links below to download age-specific forms:

1-4 Weeks 30 Months
2 Months   3 Years
4 Months   4 Years
6 Months   5 Years
9 Months   6 Years
12 Months   7-8 Years
15 Months   9-10 Years
18 Months   11-17 Years
2 Years

Contact Us

If you have questions or would like information related to specific services or topics, please visit our Contact Us page to send the EPSDT Health Care Provider Clinical Consultant a message.

If you prefer to get in touch with EPSDT Care for Kids by phone, please use the number below to speak to the EPSDT Administrative Services Coordinator.

Iowa EPSDT/Care for Kids
Telephone: 319-353-8869

Girl flexing arm

Website Accessibility

EPSDT is committed to making all information and materials accessible to everyone.

To increase the font size on pages, hold CTRL and press + (PC) or hold Command and press + (Mac). Please contact us if you need materials in alternate formats.