Iowa Child Health & Development Record

Iowa Child Health & Development Record

The Iowa EPSDT Care for Kids program developed the Iowa Child Health & Development Record (CHDR) forms to guide and document children's well visits from birth up to age 21. The CHDR forms have helped identify developmental milestones, risk factors, and potential "red flags" for referral.

Developmental red flags

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


The Iowa CHDR forms have been revised under the guidance of the EPSDT Care for Kids grant program physicians, Temitope Awelewa, MBChB, MPH, and Elizabeth Cramer, MD.

Their work was supported by the Care for Kids team based at the UI Center for Disabilities and Development, and the Care for Kids Interagency Stakeholder Workgroup, including representatives from the Iowa Department of Health and Human Services, Iowa Medicaid, the Bureau of Family Health, and 1st Five.

The original Iowa CHDR forms were developed with assistance and input from:

Revised Iowa CHDR Forms

The CHDR forms have been completely revised so that they continue to support health care providers with free-to-use health maintenance guidance for Iowa's children and youth. The newly revised forms are fillable pdfs to make them easier to use and save.

Each age-appropriate Iowa CHDR form provides:

  • An easy-to-use screening checklist with space for notes and comments to help providers 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.

Age-appropriate forms

Click links below to download age-specific forms:

0-4 Weeks 3 Years
2 Months   4 Years
4 Months   5 Years
6 Months   6 Years
9 Months   7-8 Years
12 Months   9-10 Years
15 Months   11-14 Years
18 Months   15-17 Years
24 Months 18-21 Years

           30 Months

Current Guidance

Periodicity Schedule

Please refer to the Iowa EPSDT Periodicity Schedule for current guidance on recommended exams, screenings and surveillance.

In addition to the Iowa CHDR forms, the Care for Kids program also recommends the use of Bright Futures Materials and Tools, developed and maintained by the American Academy of Pediatrics (AAP). These materials help health care providers put into practice "Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th Edition."

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