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LEGAL ACTS OF THE REPUBLIC OF LATVIA
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The translation of this document is outdated.
Translation validity: 01.03.2016.–19.07.2019.
Amendments not included: 02.07.2019.

Text consolidated by Valsts valodas centrs (State Language Centre) with amending regulations of:

15 April 2008 [shall come into force from 19 April 2008];
13 October 2009 [shall come into force from 21 October 2009];
20 September 2011 [shall come into force from 24 September 2011];
27 March 2012 [shall come into force from 1 April 2012];
8 January 2013 [shall come into force from 1 February 2013];
10 December 2013 [shall come into force from 1 January 2014];
25 November 2014 [shall come into force from 1 January 2015];
29 September 2015 [shall come into force from 3 October 2015];
16 February 2016 [shall come into force from 1 March 2016].

If a whole or part of a paragraph has been amended, the date of the amending regulation appears in square brackets at the end of the paragraph. If a whole paragraph or sub-paragraph has been deleted, the date of the deletion appears in square brackets beside the deleted paragraph or sub-paragraph.


Republic of Latvia

Cabinet
Regulation No. 265
Adopted 4 April 2006

Procedures for Keeping Medical Documents

[20 September 2011]

Issued pursuant to
Section 59 of the Medical Treatment Law

I. General Provisions

1. This Regulation prescribes the procedures for keeping medical documents in medical treatment institutions (hereinafter - the document keeping procedures).

[20 September 2011]

2. The document keeping procedures shall be binding on all medical treatment institutions of the Republic of Latvia.

3. The document keeping procedures shall be a part of the mandatory requirements defined for a medical treatment institution.

[13 October 2009]

4. The implementation of this Regulation shall be controlled by the Health Inspectorate.

[15 April 2008]

II. Entries in Medical and Register Documentation

5. Medical documents regarding receipt of a primary health care, secondary health care and emergency medical assistance (hereinafter - the medical entries) shall form a unified information unit. The medical entries shall be compiled and stored by a general practitioner (a primary health care internist, a primary health care pediatrist). The medical entries shall be electronically accumulated in a unified electronic information system of the health sector in accordance with the laws and regulations regarding the unified electronic information system of the health sector.

[10 December 2013 / New wording of this Paragraph shall come into force on 1 April 2014.]

6. If a patient changes the general practitioner (the primary health care internist, the primary health care pediatrist), the general practitioner shall transfer the complete medical entries regarding the relevant patient to the general practitioner selected by the patient.

7. The medical entries made regarding a patient in an out-patient medical treatment institution shall form an out-patient medical card of the patient. The medical entries regarding a patient made in an inpatient medical treatment institution shall form the medical history of the patient.

8. The doctor providing medical treatment shall append to the medical entries of a patient information regarding a health care service provided to a patient which is received in other medical treatment institution or which is provided by other medical treatment persons.

9. The medical entries of patients discharged from an inpatient medical treatment institution shall be completed and transferred for storage to a filing cabinet of the inpatient medical treatment institution not later than 14 days after the discharge from the inpatient medical treatment institution. A responsible medical practitioner assigned by the head of the inpatient medical treatment institution shall be responsible for the transfer of the medical entries for storage to the filing cabinet of the inpatient medical treatment institution.

9.1 The medical entries regarding health care at home shall be completed and transferred for storage to a filing cabinet of the inpatient medical treatment institution within seven days after completion of the home care episode.

[20 September 2011]

III. Content and Protection of the Medical Entries

10. The medical entries shall contain information which ensures recognition of a patient, certifies diagnosis, substantiates examinations and medical treatment methods, and also precisely demonstrates medical treatment results.

[15 April 2008]

11. The medical entries, which are to be competed in an inpatient medical treatment institution, shall also be completed by outpatient medical treatment institutions, if surgical operations or manipulations have been carried out in the outpatient operation ward of the day hospital of the relevant institution.

12. An evolution of the disease shall be entered in the medical entries within 24 hours after the patient's reception in an inpatient medical treatment institution.

13. If additional information regarding any activity related to medical treatment, manipulation and pre-operational time of a patient is obtained or submitted, it shall be added to the medical entries without delay.

14. An opinion on completion of hospitalisation may be replaced by a final entry, which contains information regarding medical treatment results and recommendations, if:

14.1. the patient must be hospitalised for a period of less than 48 hours;

14.2. a healthy child is born in labour and labour has occurred without complications.

14.1 Epicrisis regarding health care at home shall be completed in two copies, if the health care at home or episode thereof is finished. One copy shall be transferred to the general practitioner of the patient, the other copy shall be appended to the patient's medical card.

[20 September 2011]

15. If the death of a patient has occurred, an opinion on the death and a final entry, in which the reason due to which the patient has been received in a hospital (if a patient has died in the hospital), the results of examinations and medical treatment course, and also reasons of the death shall be provided, shall be added to the medical entries.

16. If an autopsy is carried out after the death of a patient, a pathological anatomical diagnosis shall be appended to the medical entries within three days, but a complete statement shall be appended to the medical entries within 30 days after the autopsy.

17. A summary is one of the parts of the medical entries of the outpatient medical treatment institution. The summary shall contain the following information:

17.1. the final diagnosis;

17.2. information regarding diseases (also infectious diseases) and injuries (according to a patient's words) suffered previously;

17.3. known significant surgical and invasive procedures;

17.4. known adverse and allergic reactions;

17.5. information regarding medicinal products to be used on regular basis.

18. The summary shall be located in an outpatient medical card of a patient at the same place. It shall be completed in the case of the first time illness and in the case of acute condition of a chronic illness, or when a patient visits a medical practitioner for the first time. Hereinafter, medical practitioners shall supplement the summary after the patient's visit. If significant information regarding the patient is also located in another medical entry, the summary shall contain an indication where the relevant information is located. Diagnosis or assessment of the condition must not be indicated repeatedly during one and the same medical treatment.

19. A patient can become familiar with information, which is included in the medical entries regarding him or her and stored in a medical treatment institution, by visiting the doctor providing medical treatment in a medical treatment institution. The duty of the doctor providing medical treatment is to provide information regarding the diagnosis of the patient, examination and treatment plan, regarding other treatment methods and prognosis of the disease included in the medical entries in an understandable way and also to explain the meaning of the content of the entries made in the medical documents.

20. [20 September 2011]

21. If the doctor providing medical treatment or the head of the medical treatment institution has determined, that a part of the medical entries contains information which is to be specially protected, it shall be kept separately on technical information carriers. In such case the place of location of the relevant part of information shall be indicated in the medical entry.

22. The head of the medical treatment institution shall ensure protection of the medical entries and information included therein against deletion, amending of facts and unauthorised use, and shall assign a medical practitioner responsible for the protection of the medical entries and information included therein (hereinafter - the responsible person).

23. Medical practitioners of the medical treatment institution involved in the medical treatment process of a patient shall, during working hours, ensure that persons, which are not involved in the medical treatment process, cannot access the medical entries of the patient and information included therein.

24. Out of the working hours of a medical treatment institution the medical entries of the patient and information included therein shall be stored in a separately locked room or locked cabinets, which do not provide access to persons not involved in treatment process. The keys of the room or cabinets shall be kept by the responsible person.

IV. Quality of the Medical Entries

25. The medical entries shall be true, complete, clearly legible and without corrections.

26. Entries in medical documents may be made only by medical practitioners. Reports regarding examinations carried out for a patient, which are drawn up electronically, shall be signed by the doctor providing medical treatment and they shall be appended to the medical entries. If a medical document is drawn up electronically in conformity with the laws and regulations regarding drawing up electronic documents, the document details "signature", "date" and "stamp" shall not be completed. Only completed sections of the medical documents drawn up electronically may be printed out on a paper.

[15 April 2008; 25 November 2014]

27. In order to certify performance of instructions by the doctor providing medical treatment in the health care of a patient, a medical practitioner shall indicate obvious facts in the medical entries. Entries provided in medical documents by a medical practitioners other than doctors shall be determined in the internal rules of procedures of a medical treatment institution. Symbols and abbreviation may be used only in those cases which are provided for in the internal rules of procedures of a medical treatment institution.

28. Pathomorphological reports, and also description of the operation and epicrisis shall be printed, except for the epicrisis regarding care at home.

[20 September 2011]

29. A medical entry is regarded to be fully completed, if it contains all necessary parts laid down in this Regulation, including epicrisis or final entry, and if all final diagnoses and complications have been entered.

30. If due to justified reasons corrections are to be made in the medical entries, retention of initial information included in the medical entries and adding thereof to the corrections shall be ensured.

V. Medical and Register Documents to be Used in Medical Treatment Institutions and Time Periods for Storage Thereof

[25 November 2014]

31. Inpatient medical treatment institutions shall use the register documents referred to in Annexes 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 15, 18, 19, 20, 22, 23, 24, 26, 28, 29, 30, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 83, 85, 89, 90, 91, 94 and 104 to this Regulation.

[16 February 2016]

32. Outpatient medical treatment institutions shall, according to their profile of activity, use the register documents referred to in Annexes 12, 15, 18, 19, 20, 22, 23, 24, 26, 30, 32, 39, 40, 41, 42, 43, 44, 45, 46, 47, 49, 51, 53, 57, 58, 60, 61, 84, 85, 89, 90, 91, 92, 94, 95, 96, 99, 100, 101, 102 and 103 to this Regulation.

[16 February 2016]

32.1 An outpatient medical treatment institutions may in conformity with their profile of activity use the register documents referred to in Annex 16 and 93 to this Regulation.

33. Medical treatment institutions other than those referred to in Paragraphs 31 and 32 of this Regulation shall use the register documents which are referred to in Annexes 62, 63, 64, 66, 68 and 85 to this Regulation.

34. Medical treatment institutions shall use the standard medical documents referred to in Annexes 54, 59, 70, 73, 75, 76, 77, 79, 80, 81 and 88 to this Regulation.

34.1 The medical treatment institution of the National Armed Forces may use the documents referred to in Annex 40 and 100 to this Regulation also outside the territory of Latvia.

[29 September 2015]

35. The medical entries which are provided:

35.1. in the documents referred to in Annexes 5, 10, 15, 18, 24, 28, 29, 39, 40, 41, 53, 63, 75, 83 and 100 to this Regulation shall be stored for one year after the last entry;

35.2. in the documents referred to in Annexes 8, 36 and 37 to this Regulation shall be stored for two years after the last entry;

35.3. in the documents referred to in Annexes 26, 62 and 85 to this Regulation shall be stored for three years after the last entry;

35.4. in the documents referred to in Annexes 4, 7, 9, 11, 23, 32, 38, 42, 45, 46, 51, 58, 60, 66, 68, 79, 80, 81, 82 and 91 to this Regulation shall be stored for five year after the last entry;

35.5. in the documents referred to in Annexes 6, 57, 90 and 99 to this Regulation shall be stored for 10 years after the last entry;

35.6. in the documents referred to in Annexes 1, 13, 19, 20, 22, 43, 44, 59, 76 and 77 to this Regulation shall be stored for 15 years after the last entry;

35.7. in the documents referred to in Annex 61 to this Regulation shall be stored for 25 years after the last entry;

35.8. in the documents referred to in Annexes 2, 3, 30, 34, 35, 47, 49, 64, 70, 73, 84, 93 and 95 to this Regulation shall be stored for 75 years after the last entry;

35.9. in the accompanying check of the document referred to in Annex 64 to this Regulation shall be stored for one year.

[29 September 2015; 16 February 2016]

35.1 Images obtained by radiological manipulations (in radiodiagnostic films or in electronic form) shall be stored for 10 years.

VI. Closing Provisions

36. Paragraphs 19, 31, 32, 33 and 34 of this Regulation shall come into force on 1 July 2006.

37. Paragraphs 20 and 24 of this Regulation shall come into force on 1 January 2007.

38. The register forms referred to in Annexes 5, 10, 19, 21, 24, 26, 29, 40, 41, 51 and 61 to this Regulation, which have been acquired before 31 December 2011, may be used no longer than until 31 December 2012.

[20 September 2011]

39. The register forms referred to in Annexes 12, 45, 46, 63, 76, 77, 83, 90 and 91 to this Regulation, which have been acquired before 1 January 2014, may be used no longer than until 31 December 2014.

[10 December 2013]

40. The register forms of medical documents referred to in Annexes 32, 40, 41 and 51 to this Regulation, which have been acquired before 1 January 2015, may be used no longer than until 30 June 2015.

[25 November 2014]

41. The register form of a medical document referred to in Annex 40 to this Regulation, which has been received before 1 October 2015, may be used until 1 October 2016.

[29 September 2015]

42. The register forms of medical documents referred to in Annexes 30, 35, 39, 42, 90 and 99 to this Regulation, which have been acquired before 1 March 2016, may be used no longer than until 1 August 2016.

[16 February 2016]

Prime Minister A. Kalvītis

Minister for Health G. Bērziņš

 

Annex 93
Cabinet Regulation No. 265
4 April 2006

[20 September 2011]

Name of the medical treatment institution  
Code           

I. Physical and mental development assessment sheet for a child from 1 week to 5 years of age1

1. Given name, surname  
2. Date of the birth (dd.mm.yyyy)   .   .     .
3. Personal identity number       -     
4. Gender (mark as appropriate) 1 - male; 2 - female
Weight at the birth _______ g height ________ cm head circumference ________ cm
Weight at the discharge ________ g
Labour/Apgar score Family anamnesis Risk factors (including genetic)
Child's age 1 week 3 weeks 1 month
Date of the visit   .   .     .
(dd.mm.yyyy)
  .   .     .
(dd.mm.yyyy)
  .   .     .
(dd.mm.yyyy)
Physical development (in addition see physical development curves in Chapter II, Sub-paragraph 1 or 3, correct, if the child is born before week 37)
Weight (g) (if possible) (if possible)  
Height (cm)      
Head circumference (cm)      
Complaints from the parents      
Feeding2; 3 Breastfeeding (exclusive)

D vitamin 10 micrograms
(400-900 IU/per day)

Formula
150 ml/kg/d
Nature of laxation
Passing of urine

Breastfeeding (exclusive)

D vitamin 10 micrograms
(400-900 IU/per day)

Formula 150 ml/kg/d
Nature of laxation
Passing of urine

Breastfeeding (exclusive)

D vitamin 10 micrograms
(400-900 IU/per day)

Formula 150 ml/kg/d
Nature of laxation
Passing of urine

Educating and advice2; 3 TRAUMA PREVENTION
Safety of the baby's bed

Sleeping position/bed sharing/sleeping in the parents' room

Car seat (infant)

Emergency telephone numbers

CO/smoke detector

Suffocation/safe toys

Hot water < 49 °C

Safety of weapons

  BEHAVIOUR AND FAMILY ISSUES
Sleep/crying

Assess the necessity to apply for a home visit by a social care provider

Eating habits of the mother

Brothers and sisters

Consolation/sympathy

Family conflicts/stress

Parental responsibility/upbringing

Parent tiredness/depression

  OTHER ISSUES
Passive smoking

Do not use medicinal products against cough/reducing cold symptoms

Temperature control/appropriate clothes

Ask regarding use of alternative medicine

Discuss the use of a teat

Sun exposure/sun protection products/insect repellents

Fever control

Information to parents3     Immunisation programme

Use of antipyretics

Development2; 3

Absence of any feature determines further assessment of the development.

Correct, if born before week 37

Sucking reflex

Reflector reaction of leg support/automatic stepping

When lying on the belly, turns the head from the middle position to the side

Good breast sucking

Reflector reaction of leg support/automatic stepping

When lying on the belly, turns the head from the middle position to the side

Parents have no concerns regarding development of the child 

Focuses sight

Reacts to a loud or sudden sound

Good breast sucking (grip and position of the breast)

When lying on the belly, lifts the head

Calms down at the feeling of comfort

Parents have no concerns regarding development of the child 

Clinical examination2; 3 It is recommended to carry out clinical examination appropriate to the age in each visit Physical examination of all organ systems

Special attention:

Skin (jaundice, dryness)

Fontanelle

Red reflex examination of eyes with ophthalmoscope

Heart/lungs

Navel/liver

Femoral pulse

Hips

External genitals/

testicles

Care of foreskin of a boy/urine jet

Muscular tonus

Physical examination of all organ systems

Special attention:

Skin (jaundice, dryness)

Fontanelle

Heart/lungs

Navel/liver

Femoral pulse

Hips

External genitals/testicles

Care of foreskin of a boy/urine jet

Muscular tonus

Physical examination of all organ systems

Special attention:

Skin (jaundice)

Fontanelle

Corneal light reflex

Heart

Hips

Muscular tonus

Problems, plans2; 3; 4; 5 Screening result of phenylketonuria (PKU) and congenital hypothyroidism (CHT)

Hearing examination with otoacoustic emissions method - testing result 

Red reflex examination of eyes with ophthalmoscope, if it has not been carried out previously

Hearing examination with otoacoustic emissions method, if it has not been carried out previously

Red reflex examination of eyes with ophthalmoscope, if it has not been carried out previously

Hearing examination with otoacoustic emissions method, if it has not been carried out previously

Health group 1 2 3 1 2 3 1 2 3
Immunisation2 According to vaccination calendar

Additional vaccination

According to vaccination calendar

Additional vaccination

According to vaccination calendar

Additional vaccination

Doctor's signature      
Child's age 2 months 3 months 4 months 6 months
Date of the visit (dd.mm.yyyy)   .   .     .   .   .     .   .   .     .   .   .     .
Physical development (in addition see physical development curves in Chapter II, Sub-paragraph 1 or 3, correct, if the child is born before week 37)
Weight (g)       (x 2 birth weight)
Height (cm)        
Head circumference (cm)        
Complaints from the parents        
Feeding2; 3 Breastfeeding (exclusive breastfeeding/mostly breastfeeding/partly breastfeeding)

D vitamin 10 micrograms
(400-900 IU/per day)

Formula 

Breastfeeding (exclusive breastfeeding/mostly breastfeeding/partly breastfeeding; discuss causes for hypogalactia)

D vitamin 10 micrograms
(400-900 IU/per day)

Formula 

Breastfeeding (exclusive breastfeeding/mostly breastfeeding/partly breastfeeding)

D vitamin 10 micrograms
(400-900 IU/per day)

Formula 

Breastfeeding

D vitamin 10 micrograms
(400-900 IU/per day)

Formula

Exclude food allergies

Fruit/vegetables

Assess necessity of food containing iron (cereal, meat)

Do not give egg white, nuts, honey

Do not give sweetened liquids

Do not give a bottle in the bed

Safe food (choking prevention)

Educating, advice2; 3 TRAUMA PREVENTION
Car seat (infant)

Sleeping position/bed sharing/sleeping in the parents' room/safety of a bed

Poisons/emergency telephone numbers

Electrical switches/sockets

CO/smoke detectors

Suffocation/safe toys

Safety of weapons

Hot water < 49 °C/bathtub safety

Falling (stairs, baby walkers, baby changing table)

BEHAVIOUR AND FAMILY ISSUES
Sleep/crying/waking up at night 

Parental responsibility/upbringing

Assess the necessity to apply for a home visit by a social care provider

Consolation/sympathy

Parent tiredness/depression

Family conflicts/stress

Brothers and sisters

Returning at work/necessity of a nanny

OTHER ISSUES
Passive smoking 

Teething/teeth care/fluorine 

Fever control

Temperature control/appropriate clothes

Food quality (pesticides)

Discuss the use of a teat

Sun exposure/sun protection products/insect repellents

Ask regarding use of alternative medicine

Do not use medicinal products against cough/reducing cold symptoms

Read aloud 

Information to parents3     Immunisation programme

Use of antipyretics

 
Development2; 3

Absence of any feature determines further assessment of the development.

Correct, if born before week 37

Follows to a movement with eyes

Makes sounds and crows ("chats" or intonative screaming)

When applied to a shoulder of an adult, holds the head

Likes touches and cuddles

Replies with a smile

When eating two or several sucking episodes before swallowing

Parents have no concerns regarding development of the child 

With eyes and turning the head above centre line, follows to a movement

"Social smile"

The first strings of syllables

Is stable when supporting on forearms

Parents have no concerns regarding development of the child 

Laughs/shrieks in a dialogue with parents

Answers to people with excitement

Holds stable his or her head, if he or she is supported on a shoulder or put in a seating position

Accepts position on the belly

Makes rhythmic strings of syllables (sounds)

Holds a subject for a short time period, if it is put in a hand

Follows moving toy or person with eyes

Parents have no concerns regarding development of the child 

Turns his or her head to the direction of a sound

Follows a moving object

Babbling/makes syllables in different sound volume, tonality

Shows joy or dislike with his or her voice

Replies with a voice when somebody speaks with him or her

Support on opened palms in the position on the belly

Rolls from back to belly and vice versa

Sits with a support

Reaches/grasps toys

Parents have no concerns regarding development of the child 

Clinical examination2; 3 It is recommended to carry out clinical examination appropriate to the age in each visit Physical examination of all organ systems

Special attention:

Fontanelle

Heart

Hips

Muscular tonus

Physical examination of all organ systems

Special attention:

Fontanelle

Red reflex examination of eyes

with ophthalmoscope

Light reflex of cornea

Ask about hearing

Heart

Hips

Muscular tonus

Physical examination of all organ systems

Special attention:

Fontanelle

Ask about hearing

Hips

Muscular tonus

Physical examination of all organ systems

Special attention:

Fontanelle

Red reflex examination of eyes with ophthalmoscope

Corneal light reflex/examination of strabismus with cover test

Ask about hearing

Hips

Muscular tonus

Problems, plans2; 3 Red reflex examination of eyes with ophthalmoscope, if it has not been carried out previously

Corneal light reflex examination, if it has not been carried out previously

Hearing examination with otoacoustic emissions method, if it has not been carried out previously

  Red reflex examination of eyes with ophthalmoscope, if it has not been carried out at 3 months of age

Corneal light reflex examination, if it has not been carried out at 3 months of age

 
Health group 1 2 3 1 2 3 1 2 3 1 2 3
Immunisation3 According to vaccination calendar

Additional vaccination

According to vaccination calendar

Additional vaccination

According to vaccination calendar

Additional vaccination

According to vaccination calendar

Additional vaccination

Doctor's signature        
Child's age 9 months
(additional check-up from 7 to 11 months)
12 months 15 months
Date of the visit (dd.mm.yyyy)   .   .     .
  .   .     .
  .   .     .   .   .     .
Physical development (in addition see physical development curves in Chapter II, Sub-paragraph 1 or 3, correct, if the child is born before week 37)
Weight (g)     (x 3 birth weight)  
Height (cm)        
Head circumference (cm)     (approximately 47 cm)  
Complaints from the parents        
Feeding2; 3 Breastfeeding

D vitamin 10 micrograms
(400-900 IU/per day)

Formula

Do not give a bottle in the bed

Do not give sweetened beverages

Cereal, fruit, vegetables, meat/alternatives

Getting familiar with cow's milk products

Do not give egg white, nuts, honey

Safe food (choking prevention)

Breastfeeding

D vitamin 10 micrograms
(400-900 IU/per day)

Formula or 2 % cow milk

Encourage to use a cup instead of a bottle

Lower appetite

Safe food (choking prevention)

Breastfeeding

D vitamin 10 micrograms
(400-900 IU/per day)

Formula or 2 % cow milk

Encourage to use a cup instead of a bottle

Safe food (choking prevention)

Educating and advice2; 3 TRAUMA PREVENTION
Car seat (infant/child)

Poisons/emergency telephone number

Safety of weapons

CO/smoke detectors

Electrical switches/sockets

Suffocation/safe toys

Hot water < 49°C/bathtub safety

Falling (stairs, baby walkers) 

  BEHAVIOUR AND FAMILY ISSUES
Sleep/crying/waking up at night 

Parental responsibility/upbringing

Assess the necessity to apply for a home visit by a social care provider

Consolation/sympathy

Parent tiredness/depression

Family conflicts/stress

Brothers and sisters

Necessity of a kindergarten/babysitter

OTHER ISSUES
Passive smoking 

Teething/teeth care/fluorine/dentist 

Fever control

Food quality (pesticides)

Discuss the use of a teat

Sun exposure/sun protection products/insect repellents

Ask regarding use of alternative medicine

Environment (lead) Footwear Active and healthy lifestyle/environment

Do not use medicinal products against cough/reducing cold symptoms

Read aloud 

Information to parents    
Development2; 3

Absence of any feature determines further assessment of the development.

Correct, if born before week 37

Seeks after hidden toys

Uses clear double-syllables

Reacts differently to different people

Uses sounds to pay attention to himself or herself

Sits without a support

Stands with holding on to something

Plays social games (touches his or her nose)

Reaches to be hold up

Puts thumb and pointing finger together

Parents have no concerns regarding development of the child 

Responds to his or her name

Understands simple instructions

First words or syllables with a meaning

Tries to pronounce 3 or more words (may be unclear)

Crawls or slips

Stands up/stands freely

Walks with holding on something

Shows emotions according to a situation

Grasps a tiny object with a thumb and bent pointing finger

Reacts painfully to parting from parents/carer

Parents have no concerns regarding development of the child 

Tries to pronounce 5 or more words (may be unclear)

Tries to obtain something with help of sounds or gestures

Grasps and eats with fingers

Crawls some steps up the stairs

Shows fear from strange people/places

Tries to squat to take a toy from the floor

Takes off socks, tries to open shoelaces

Makes a pyramid of two blocks

Watches the reaction of adults in order to understand how to react (when falling down himself or herself)

Parents have no concerns regarding development of the child 

Clinical examination2; 3 It is recommended to carry out clinical examination appropriate to the age in each visit Physical examination of all organ systems

Special attention:

Fontanelle

Ask about hearing

Hips

Physical examination of all organ systems

Special attention:

Fontanelle

Ask about hearing

Size of tonsils/teeth

Hips

Physical examination of all organ systems

Special attention:

Fontanelle

Ask about hearing

Size of tonsils/teeth

Hips

Problems, plans2; 3 Red reflex examination of eyes with ophthalmoscope, if it has not been carried out at 6 months of age

Corneal light reflex/

examination of strabismus with cover test, if it has not been carried out at 6 months of age

Haemoglobin concentration in blood  Examination by an oculist (once in 13-24 months of age)

Red reflex examination of eyes with ophthalmoscope, if examination by an oculist has not been carried out

Corneal light reflex/examination of strabismus with cover test, if examination by an oculist has not been carried out

Health group 1 2 3 1 2 3 1 2 3
Immunisation3 According to vaccination calendar

Additional vaccination

According to vaccination calendar

Additional vaccination

According to vaccination calendar

Additional vaccination

Doctor's signature      
Child's age 18 months 2 years 3 years 4 years 5 years
Date of the visit   .   .     .
(dd.mm.yyyy)
  .   .     .
(dd.mm.yyyy)
  .   .     .
(dd.mm.yyyy)
  .   .     .
(dd.mm.yyyy)
  .   .     .
(dd.mm.yyyy)
Physical development (in addition see physical development curves in Chapter II, Sub-paragraph 1 or 3, but starting from 2 years of age - Sub-paragraph 2 or 4, correct, if the child is born before week 37, until 2-3 years of age)
Weight (g)      
Height (cm)      
Head circumference (cm)   (if was not normal)
Complaints from the parents      
Feeding2; 3 Breastfeeding

D vitamin 10 micrograms
(400-900 IU/per day)

Formula or 2 % cow milk

Feed not using a bottle

D vitamin 10 micrograms
(400-900 IU/per day)

Formula or 2 % cow milk

Feeding recommendations

Gradual transition to food with a lower fat content 

2 % milk

Feeding recommendations

Educating and advice2; 3 TRAUMA PREVENTION
Car seat (child)

Bathtub safety 

Suffocation/safe toys

Car seat (child)

Protective helmet/protectors

Emergency telephone number

CO/smoke detectors

Safety-matches

Safety on water

Safety of weapons

BEHAVIOUR AND FAMILY ISSUES
Parent/children contact

Discipline/restrictions 

Parent tiredness/stress/depression

High social risk child 

Parent/children contact

Discipline/restrictions

Parent tiredness/stress/depression

High social risk child

Brothers and sisters

Family conflicts

OTHER ISSUES
  Socialisation/role games

Teeth care/dentist

Learning to use a toilet/hygiene

Break using of a teat

Read aloud 

Teeth care/fluorine/dentist 

Ask regarding use of alternative medicine

Active and healthy lifestyle/environment

Passive smoking

Learning to use a toilet/hygiene

Assess readiness for pre-school institution/school

Socialisation possibilities

Sun exposure/sun protection products/insect repellents

Food quality (pesticides)

Environment (lead)

Do not use teat

Do not use medicinal products against cough/reducing cold symptoms

Read aloud

Information to parents      
Development2; 3

Absence of any feature determines further assessment of the development.

Correct, if born before week 37

Usually the child's behaviour can be controlled easily

He or she has interest about other children

Usually he or she can be calmed down easily

Seeks for support when in sorrow

Indicates to several different body parts

Tries to attract attention in order to show something

Turns when his or her name is called

Indicates to something he or she wants

Seeks a toy when he or she is asked to do it

Imitates speech sounds knowingly

Pronounces 20 or more words (may be unclear)

Can say three different consonants

Walks freely

Eats with a spoon unaided

Takes off a bonnet/socks unaided

Parents have no concerns regarding development of the child 

2 years

At least one new word per week

Two-word sentences

Understands one or two-stage instructions (take the small ball and give to mummy)

Makes two steps backwards without a support

Tries to run

Puts an object in a small container

Imitates his or her parents (gives a doll to drink)

Continues to acquire new skills

Parents have no concerns regarding development of the child

4 years

Understands related directions to three sides

Asks many questions and replies (what are you doing?)

Uses simple compound sentences

Stands on one leg 1-3 sec.

Goes up the stairs by alternating feet

Draws people with at least three body parts

Uses the toilet during the day

Opens buttons and zip-fastener

Tries to calm down somebody who is sad

Parents have no concerns regarding development of the child 

3 years

Understands two-stage and three-stage instructions (take the hat and shoes and put them in the wardrobe)

Uses sentences with 5 or more words

Goes up the stairs with adding step, by holding to handrails

Twists off lids from dishes/turns switches

Plays behaviour games with actions and words (pretends that he or she is cooking, repairing a car)

Spends a short period of time together with known people without parents/carer

Turns over book pages one by one

Imitates writing movements

Draws a circle

Listens to music or stories for 5-10 min. together with an adult

Parents have no concerns regarding development of the child 

5 years

Counts aloud or on fingers in order to answer "how many?"

Knows basic colours and forms

Speaks clearly for the most part of the time

Uses complex sentences

Throws and catches a ball

Is engaged with one activity for 20-30 min. alone

Can dress himself or herself with minimum assistance

Shares willingly

Hops on one leg

Retells episodes of a story

Easily parts from parents/carer

Parents have no concerns regarding development of the child 

Clinical examination2; 3 It is recommended to carry out clinical examination appropriate to the age in each visit Physical examination of all organ systems

Special attention:

Fontanelles are closed

Ask about hearing

Size of tonsils/teeth

Physical examination of all organ systems

Special attention:

Red reflex examination of eyes with ophthalmoscope/vision sharpness

Corneal light reflex/examination of strabismus with cover test

Ask about hearing

Size of tonsils/teeth

Blood pressure 

Physical examination of all organ systems

Special attention:

Ask about hearing

Size of tonsils/teeth

Blood pressure 

Problems, plans2; 3 Examination by an oculist, if it has not been carried out previously

Red reflex examination of eyes with ophthalmoscope, if examination by an oculist has not been carried out

Corneal light reflex/examination of strabismus with cover test, if examination by an oculist has not been carried out

Examination by an oculist at 3 years of age

Dental hygienist at 2 years of age

Dental hygienist at 3 years of age

Consultation of a speech therapist/audio speech therapist, where necessary

Dental hygienist at 4 years of age

Dental hygienist at 5 years of age

Red reflex examination of eyes with ophthalmoscope/vision sharpness, if examination by an oculist has not been carried out at 3 years of age

Corneal light reflex/examination of strabismus with cover test, if examination by an oculist has not been carried out at 3 years of age

Consultation of a speech therapist/audio speech therapist, where necessary

Health group 1 2 3 1 2 3 1 2 3
Immunisation3 According to vaccination calendar

Additional vaccination

According to vaccination calendar

Additional vaccination

According to vaccination calendar

Additional vaccination

Doctor's signature      

Notes.

1 Adapted, by using Leslie Rourke, Denis Leduc and James Rourke "Rourke Baby Record" of May, 2006, and August, 2009.

2 Degree of evidence: in bold - proved good; italic - proved on average; standard - without evidence, but there is a consensus (agreement) by specialists.

3 Designations when completing a card: √ - no problem, X - a problem.

4 Screening of phenylketonuria (PKU) and congenital hypothyroidism (CHT) shall be carried out on 4th-5th day of life.

5 Hearing examination with otoacoustic emissions method shall be carried out on 3rd-4th day of life. Pay attention to children who are born in planned out-of-hospital labour, because examination of children born in a hospital is carried out in a labour ward.

II. Norms of physical development of children

1. Percentile card of girls' head circumference, body height and body weight from the birth until 24 months of age

2. Percentile card of girls' body height, body weight and BMI from 2 until 18 years of age

3. Percentile card of boys' head circumference, body height and body weight from the birth until 24 months of age

4. Percentile card of boys' body height, body weight and BMI from 2 to 18 years of age


Translation © 2017 Valsts valodas centrs (State Language Centre)

 
Document information
Status:
In force
in force
Issuer: Cabinet of Ministers Type: regulation Document number: 265Adoption: 04.04.2006.Entry into force: 08.04.2006.Publication: Latvijas Vēstnesis, 57, 07.04.2006.
Language:
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132359
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