Welcome to the Children’s Mercy Hospital Abdominal Pain Clinic (APC) child history form! This information is very important to us and will be reviewed by the Abdominal Pain Team as part of your child’s initial evaluation visit.

The APC child history form usually takes 15-30 minutes to complete. You will need to complete this form at one time, as there is no way to return to the form later.

Before you begin, please have the following information available:

  • your child’s medical history;
  • a list of your child’s current medications;
  • a list of any other treatments tried for your child’s abdominal pain (including medications, counseling, etc.); and,
  • your family’s medical history.

When you are ready, please enter the password (given to you when your appointment was scheduled) below to begin completing your child’s history form.

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