The Health Visitor First Visit form is generally completed at around 10 days after the birth of the child. This begins the child"s electronic surveillance record and gathers basic identification, family and social data.

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https://www.isdscotland.org/Health-Topics/Child-Health/Child-Health-Programme/Child-Health-Systems-Programme-Pre-hall4.asp

The Health Visitor First Visit form is generally completed at around 10 days after the birth of the child. This begins the child"s electronic surveillance record and gathers basic identification, family and social data. Examples of information collected include: mother"s age; smokers in household and infant feeding (at birth, hospital discharge and current method). Identification data such as name, address, GP etc are also checked and updated.

HDR UK

National Services Scotland

List of any issues likely to be relevant to the child’s ongoing health, development, or wellbeing.  Up to 4 issues can be recorded on any one form.  Extra forms can be used to record additional issues if required.  There is no upper limit to the number issues that can be recorded on the system.

Summary  List of issues

Issues / Issues Status / Read Coding.   Recall & Unscheduled reviews

Read code relevant to each issue listed by the Health Visitor responsible for the child health review (see above)

Read code

Indicates the status of each listed issue 
0	(referred/assistance requested) 
1	(issue ongoing) 
2	(no longer has issue) 
3	(amend issue) 
4	(no information available) 
5	(issue/code incorrectly recorded) 
6	(discharged due to DNA – did           not attend)

Issue status

Place of birth

Demographic / Birth details

Name of General Practitioner where the child is registered on CHI

Name of General Practice or community clinic where the child is registered

GP/TC name

Name/address/ postcode

CHI no

Has child received Vitamin K by intramuscular injection  or orally?

Vitamin K given

Date Health Visitor first visit was completed

Date of visit / review / assessment

During the child health review, has the child’s carer raised specific concerns about any of the areas listed?

Concerns raised by carer

General Practice or community clinic where the child where the child should be scheduled to receive routine childhood immunisations

SIRS TC no

Mothers DOB

Health Visitor identification number for Health Visitor responsible for the child’s care

Health Visitor

Gender

Health district/locality of child’s residence

Parental consent for child to be invited for childhood immunisations through the SIRS system OR HV indication of whether an appointment should be issued for the child’s first primary immunisations – or not if these are to be done during the 6-8 week review

Schedule for immunisation

Country of birth of child / parents / grandparents

TB risk status

Is English the main language spoken in the child’s home?

Is English 1st language at home?

Time

If any pre-printed demographic data is incorrect it should be updated in the Change of Details box 
Updated Health Visitor identification number for Health Visitor responsible for the child’s care

Change of

Has BCG been given?

Is the child routinely exposed to more than one spoken language in their home and/or care environment?

Bilingual/multilingual

Child’s ethnicity as stated by their primary carer

Ethnicity

General Practice or community clinic where the child should be scheduled to receive child health reviews

Treatment Centre

Carer(s) present with child at review.  Primary carer refers to the adult living (at least most of the time) with the child who provides most day to day care.

Carer present with child (At Review)

Birth Weight

General Practice or community clinic where child should be scheduled for child health reviews

CHSP TC no

Is the child currently (at the time of the review) looked after by the Local Authority for any reason?

Current LAC status

Record of specific actions the Health Visitor intends to take to support the child/family following the child health review. 
‘Provide’ indicates that the Health Visitor and/or associated skill mix team will directly provide the specified additional support (only relevant for some options). ‘Signposted to’ indicates that parents have been given details of specified local services and how to access them. 
‘Discuss with’ indicates that the Health Visitor will formally discuss the child/family with the specified service to inform future management plans. 
‘Request assistance from’ indicates that the Health Visitor will formally refer the child/family to the specified service, whilst retaining responsibility for oversight of the child’s wellbeing and outcomes as their GIRFEC named person. 
W ‘Refused’ indicates that the carer has been offered provision/ signposting/ discussion/ referral to the specified service but has refused this.

Future Action

Method of feeding that the child has received over the 24 hours prior to their child health review. 
B  (breast milk only) 
F  (formula milk only) 
M  (mixed breast & formula milk) 
O  (other) 
U  (unknown)

Current feeding

Feeding details

From birth has the baby only ever been fed breast milk and no other liquids or solids apart from medicines or vitamins?

Always exclusively breast fed

Since birth has the child ever been put to the breast to feed or been given expressed breast milk?

Ever breast fed

Age of the baby when they were last breastfed (either put to the breast to feed or given expressed breast milk)

Child’s age when breastfeeding stopped: weeks, days

Signature and name of the health professional(s) completing the CHSP-PS form

Signature Print name

Health Plan Indicator / Support Needs Status / Parental Consent

Professional identification number of the health professional(s) completing the CHSP-PS form

ID No:

Location(s) where the child health review was delivered

Place of review:

Health professional(s) directly involved in delivering the child health review 	Must complete one box with Y (yes)

Practitioners involved in review:

Any additional information the Health Visitor wishes to record

Summary comment

Summary indicator of the child’s overall need for ongoing support. 
An additional HPI indicates that the child (and/or their carer) requires sustained (>3 months) additional input from professional services to help the child attain their health or development potential.  Any services may be required such as additional Health Visitor support, parenting support, enhanced early learning and childcare, specialist medical input, etc. 
C (core) 
A (additional) 
U (unknown)

Health plan indicator

The Health Visitor First Visit form is generally completed at around 10 days after the birth of the child. This begins the child's electronic surveillance record and gathers basic identification, family and social data.

The Health Visitor First Visit form is generally completed at around 10 days after the birth of the child. This begins the child's electronic surveillance record and gathers basic identification, family and social data. Examples of information collected include: mother's age; smokers in household and infant feeding (at birth, hospital discharge and current method). Identification data such as name, address, GP etc are also checked and updated.

Child Health Systems Programme - First Visit

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