Objective — Physical Exam — Pediatric well and sports participation
PHYSICAL EXAM: [checkbox name="PEsports" value="Sports Eval"][conditional field="PEsports" condition="(PEsports).is('Sports Eval')"] -Vitals: [checkbox value="reviewed|no remarkable abnormalities|hypertensive"] -Visual acuity: [checkbox value="reviewed|no remarkable abnormalities|decreased visual acuity"] -Hearing: [text default="no overt/gross hearing loss detected" size="80"] -General: [text default="WD/WN/NAD, non-ill appearing" size="80"] -Heart: [text memo="free text" memo_size="small" size="80"][checkbox value="RRR|normal S1/S2|No M/R/G|No S3/S4 auscultated|no murmur detected on dynamic/valsalva testing|no friction rub"] [comment memo="abnormals" memo_color="orange" memo_size="small"][checkbox name="examheartabn1" value="MURMUR AUSCULTATED"][/conditional][conditional field="examheartabn1" condition="(examheartabn1).is('MURMUR AUSCULTATED')"] - GRADE [text size="3"]/6 [select value="SYSTOLIC EJECTION|SYSTOLIC|DIASTOLIC|HOLOSYSTOLIC"] HEARD BEST AT [select value="R|L"] [checkbox value="UPPER STERNAL BORDER|LOWER STERNAL BORDER|APEX|WITH DYNAMIC/VALSALVA TEST"] [/conditional][conditional field="PEsports" condition="(PEsports).is('Sports Eval')"] -Lungs: [text memo="free text" memo_size="small" size="80"][checkbox value="CTAB|BSE b/l|no wheezes|no crackles|no rhonchi"] [comment memo="abnormals" memo_color="orange" memo_size="small"][checkbox name="examlungsabn1" value="WHEEZING-"][/conditional][conditional field="examlungsabn1" condition="(examlungsabn1).is('WHEEZING-')"] [checkbox value="EXPIRATORY|INSPIRATORY|B/L LUNGS|R LUNG|L LUNG|DIFFUSE|LOWER FIELD(S)|UPPER FIELD(S)"] [/conditional][conditional field="PEsports" condition="(PEsports).is('Sports Eval')"][checkbox name="examlungsabn2" value="RHONCHI-"][/conditional][conditional field="examlungsabn2" condition="(examlungsabn2).is('RHONCHI-')"] [checkbox value="EXPIRATORY|INSPIRATORY|B/L LUNGS|R LUNG|L LUNG|DIFFUSE|LOWER FIELD(S)|UPPER FIELD(S)"] [/conditional][conditional field="PEsports" condition="(PEsports).is('Sports Eval')"][checkbox name="examlungsabn3" value="BREATH SOUNDS DIMINISHED-"][/conditional][conditional field="examlungsabn3" condition="(examlungsabn3).is('BREATH SOUNDS DIMINISHED-')"] [checkbox value="B/L LUNGS|R LUNG|L LUNG|DIFFUSE|LOWER FIELD(S)|UPPER FIELD(S)"][/conditional][conditional field="PEsports" condition="(PEsports).is('Sports Eval')"] -MSK: [comment memo="only select those MSK items that were abnormal" memo_size="small"] [checklist value="Abnormalities/defects in Neck ROM|Abnormalities/defects in Resisted Shoulder Shrug|abnormalities/defects in resisted arm abduction at 90deg|Abnormalities/defects in active shoulder ext rotation at 90deg abduction & elbows at 90deg|Abnormalities/defects in Elbow ROM|Abnormalities/defects Wrist supination/pronation ROM|Abnormalities/defects in finger MCP/PIP/DIP ROM|Abnormalities/defects in hip/knee/ankle strength/ROM/stability (duck walk)|Abnormalities/defects in spine/shoulder height/alignment|Abnormalities/defects in calves/achilles tone/strength/ROM"][textarea memo="description of MSK abnormals" memo_size="small" memo_color="orange"] [/conditional][checkbox name="PEwellvisit" value="Well Visit"][conditional field="PEwellvisit" condition="(PEwellvisit).is('Well Visit')"] for [select name="Q1" value="|3-5 day|1 month|2 month|4 month|6 month|9 month|12 month|15 month|18 month|2 year|2.5 year (30mo)|3 year|4 year|5-6 year|7-8 year|9-10 year|11-14 year|15-17 year|18-21 year"] [select name="Q2" value="|female|male"] patient [/conditional][conditional field="Q1|Q2" condition="((Q1).is('3-5 day')||(Q1).is('1 month'))&&((Q2).is('male'))"] [text size=80 default="Skin: Normal turgor and without lesions."] [text size=80 default="Eyes: Red reflex present bilaterally. Pupils equally round and reactive to light"] [text size=80 default="Head: Normocephalic with age appropriate fontanelles."] [text size=80 default="Peripheral Vessels: Normal pulses and perfusion."] [text size=80 default="Heart: Regular rate and rhythm; normal S1 and S2; no murmurs, gallops, or rubs."] [text size=80 default="Lungs: Unlabored respirations; symmetric chest expansion; clear breath sounds."] [text size=80 default="Abdomen: Soft, without organomegaly. Bowel sounds normal. Nontender without rebound. No masses palpable. No distention."] [text size=80 default="Genitalia: Normal male external genitalia. Testes descended bilaterally. No hernia present."] [text size=80 default="Spine: Straight with no lesions."] [text size=80 default="Joints: Hips with full range-of-motion; negative Barlow and Ortolani."] [text size=80 default="Extremities: No clubbing, cyanosis, or edema. Normal upper and lower extremities."] [text size=80 default="Mental Status: Alert and in no distress. Appropriate for age."] [text size=80 default="Neuro: Normal reflexes; normal tone; no focal deficits appreciated. Appropriate for age."] [/conditional][conditional field="Q1|Q2" condition="((Q1).is('3-5 day')||(Q1).is('1 month'))&&((Q2).is('female'))"] [text size=80 default="Skin: Normal turgor and without lesions."] [text size=80 default="Eyes: Red reflex present bilaterally. Pupils equally round and reactive to light"] [text size=80 default="Head: Normocephalic with age appropriate fontanelles."] [text size=80 default="Peripheral Vessels: Normal pulses and perfusion."] [text size=80 default="Heart: Regular rate and rhythm; normal S1 and S2; no murmurs, gallops, or rubs."] [text size=80 default="Lungs: Unlabored respirations; symmetric chest expansion; clear breath sounds."] [text size=80 default="Abdomen: Soft, without organomegaly. Bowel sounds normal. Nontender without rebound. No masses palpable. No distention."] [text size=80 default="Genitalia: Normal female external genitalia. No hernia present."] [text size=80 default="Spine: Straight with no lesions."] [text size=80 default="Joints: Hips with full range-of-motion; negative Barlow and Ortolani."] [text size=80 default="Extremities: No clubbing, cyanosis, or edema. Normal upper and lower extremities."] [text size=80 default="Mental Status: Alert and in no distress. Appropriate for age."] [text size=80 default="Neuro: Normal reflexes; normal tone; no focal deficits appreciated. Appropriate for age."] [/conditional][conditional field="Q1|Q2" condition="((Q1).is('2 month')||(Q1).is('4 month')||(Q1).is('6 month')||(Q1).is('9 month'))&&((Q2).is('male'))"] [text size=80 default="General: Child appears age appropriate. "] [text size=80 default="Vitals noted and stable."] [text size=80 default="Skin: Normal turgor and without lesions."] [text size=80 default="Head: Normocephalic with age appropriate fontanelles."] [text size=80 default="Eyes: Conjunctivae noninjected; sclerae anicteric; lids without ptosis, edema, or erythema; extraocular movements intact; pupils equal, round, and reactive to light. Red reflex present bilaterally."] [text size=80 default="ENT: TMs gray, sharp landmarks, mobile. Nose clear. Palate is complete. Dentition normal for age. Tonsils small and non-inflamed bilaterally."] [text size=80 default="Lymph Nodes: No significant lymphadenopathy."] [text size=80 default="Thyroid: No thyromegaly; trachea midline without masses."] [text size=80 default="Breasts: Without lesions or drainage."] [text size=80 default="Heart: Regular rate and rhythm; normal S1 and S2; no murmurs, gallops, or rubs."] [text size=80 default="Lungs: Unlabored respirations; symmetric chest expansion; clear breath sounds; no wheezes, crackles, rales, rhonchi, or retractions."] [text size=80 default="Abdomen: Soft, without organomegaly. Bowel sounds normal. Non-tender without rebound. No masses palpable. No distention."] [text size=80 default="Genitalia: Normal male external genitalia; testes descended bilaterally; no hernia."] [text size=80 default="Spine: Straight with no lesions."] [text size=80 default="Joints: Full range of motion about all joints."] [text size=80 default="Extremities: Peripheral pulses are equal. There is no clubbing, cyanosis or edema of the extremities. Capillary refill is less than 2 seconds."] [text size=80 default="Gait: Normal and appropriate gait for age."] [text size=80 default="Mental Status: Alert and in no distress. Appropriate for age."] [text size=80 default="Neuro: Normal reflexes; normal tone; no focal deficits appreciated. Appropriate for age."] [/conditional][conditional field="Q1|Q2" condition="((Q1).is('2 month')||(Q1).is('4 month')||(Q1).is('6 month')||(Q1).is('9 month'))&&((Q2).is('female'))"] [text size=80 default="General: Child appears age appropriate. Vitals noted and stable."] [text size=80 default="Skin: Normal turgor and without lesions."] [text size=80 default="Head: Normocephalic with age appropriate fontanelles."] [text size=80 default="Eyes: Conjunctivae noninjected; sclerae anicteric; lids without ptosis, edema, or erythema; extraocular movements intact; pupils equal, round, and reactive to light. Red reflex present bilaterally."] [text size=80 default="ENT: TMs gray, sharp landmarks, mobile. Nose clear. Palate is complete. Dentition normal for age. Tonsils small and non-inflamed bilaterally."] [text size=80 default="Lymph Nodes: No significant lymphadenopathy."] [text size=80 default="Thyroid: No thyromegaly; trachea midline without masses."] [text size=80 default="Breasts: Without lesions or drainage."] [text size=80 default="Heart: Regular rate and rhythm; normal S1 and S2; no murmurs, gallops, or rubs."] [text size=80 default="Lungs: Unlabored respirations; symmetric chest expansion; clear breath sounds; no wheezes, crackles, rales, rhonchi, or retractions."] [text size=80 default="Abdomen: Soft, without organomegaly. Bowel sounds normal. Non-tender without rebound. No masses palpable. No distention."] [text size=80 default="Genitalia: Normal female external genitalia."] [text size=80 default="Spine: Straight with no lesions."] [text size=80 default="Joints: Full range of motion about all joints."] [text size=80 default="Extremities: Peripheral pulses are equal. There is no clubbing, cyanosis or edema of the extremities. Capillary refill is less than 2 seconds."] [text size=80 default="Gait: Normal and appropriate gait for age."] [text size=80 default="Mental Status: Alert and in no distress. Appropriate for age."] [text size=80 default="Neuro: Normal reflexes; normal tone; no focal deficits appreciated. Appropriate for age."] [/conditional][conditional field="Q1|Q2" condition="((Q1).is('12 month')||(Q1).is('15 month')||(Q1).is('18 month')||(Q1).is('2 year')||(Q1).is('3 year')||(Q1).is('4 year'))&&((Q2).is('male'))"] [text size=80 default="General: Child appears age appropriate. Vitals noted and stable."] [text size=80 default="Skin: Normal turgor and without lesions."] [text size=80 default="Head: Normocephalic."] [text size=80 default="Eyes: Conjunctivae noninjected; sclerae anicteric; lids without ptosis, edema, or erythema; extraocular movements intact; pupils equal, round, and reactive to light. Red reflex present bilaterally. Symmetric light reflex."] [text size=80 default="ENT: TMs gray, sharp landmarks, mobile. Nose clear. Palate is complete. Dentition normal for age. Tonsils small and non-inflamed bilaterally."] [text size=80 default="Lymph Nodes: No significant lymphadenopathy."] [text size=80 default="Thyroid: No thyromegaly; trachea midline without masses."] [text size=80 default="Breasts: Without lesions or drainage."] [text size=80 default="Heart: Regular rate and rhythm; normal S1 and S2; no murmurs, gallops, or rubs. "] [text size=80 default="Lungs: Unlabored respirations; symmetric chest expansion; clear breath sounds; no wheezes, crackles, rales, rhonchi, or retractions."] [text size=80 default="Abdomen: Soft, without organomegaly. Bowel sounds normal. Non-tender without rebound. No masses palpable. No distention."] [text size=80 default="Genitalia: Normal male external genitalia; testes descended bilaterally; no hernia."] [text size=80 default="Spine: Straight with no lesions."] [text size=80 default="Joints: Full range of motion about all joints."] [text size=80 default="Extremities: Peripheral pulses are equal. There is no clubbing, cyanosis or edema of the extremities. Capillary refill is less than 2 seconds."] [text size=80 default="Gait: Normal and appropriate gait for age."] [text size=80 default="Mental Status: Alert and in no distress. Appropriate for age."] [text size=80 default="Neuro: Normal reflexes; normal tone; no focal deficits appreciated. Appropriate for age."] [/conditional][conditional field="Q1|Q2" condition="((Q1).is('12 month')||(Q1).is('15 month')||(Q1).is('18 month')||(Q1).is('2 year')||(Q1).is('2.5 year (30mo)')||(Q1).is('3 year')||(Q1).is('4 year'))&&((Q2).is('female'))"] [text size=80 default="General: Child appears age appropriate. Vitals noted and stable."] [text size=80 default="Skin: Normal turgor and without lesions."] [text size=80 default="Head: Normocephalic."] [text size=80 default="Eyes: Conjunctivae noninjected; sclerae anicteric; lids without ptosis, edema, or erythema; extraocular movements intact; pupils equal, round, and reactive to light. Red reflex present bilaterally. Symmetric light reflex."] [text size=80 default="ENT: TMs gray, sharp landmarks, mobile. Nose clear. Palate is complete. Dentition normal for age. Tonsils small and non-inflamed bilaterally."] [text size=80 default="Lymph Nodes: No significant lymphadenopathy."] [text size=80 default="Thyroid: No thyromegaly; trachea midline without masses."] [text size=80 default="Breasts: Without lesions or drainage."] [text size=80 default="Heart: Regular rate and rhythm; normal S1 and S2; no murmurs, gallops, or rubs. "] [text size=80 default="Lungs: Unlabored respirations; symmetric chest expansion; clear breath sounds; no wheezes, crackles, rales, rhonchi, or retractions."] [text size=80 default="Abdomen: Soft, without organomegaly. Bowel sounds normal. Non-tender without rebound. No masses palpable. No distention."] [text size=80 default="Genitalia: Normal female external genitalia."] [text size=80 default="Spine: Straight with no lesions."] [text size=80 default="Joints: Full range of motion about all joints."] [text size=80 default="Extremities: Peripheral pulses are equal. There is no clubbing, cyanosis or edema of the extremities. Capillary refill is less than 2 seconds."] [text size=80 default="Gait: Normal and appropriate gait for age."] [text size=80 default="Mental Status: Alert and in no distress. Appropriate for age."] [text size=80 default="Neuro: Normal reflexes; normal tone; no focal deficits appreciated. Appropriate for age."] [/conditional][conditional field="Q1|Q2" condition="((Q1).is('5-6 year')||(Q1).is('7-8 year')||(Q1).is('9-10 year')||(Q1).is('11-14 year')||(Q1).is('15-17 year')||(Q1).is('18-21 year'))&&((Q2).is('male'))"] [text size=80 default="General: Child appears age appropriate. Vitals noted and stable."] [text size=80 default="Skin: Normal turgor and without lesions."] [text size=80 default="Head: Normocephalic."] [text size=80 default="Eyes: Conjunctivae noninjected; sclerae anicteric; lids without ptosis, edema, or erythema; extraocular movements intact; pupils equal, round, and reactive to light. Symmetric light reflex, normal fundi."] [text size=80 default="ENT: TMs gray, sharp landmarks, mobile. Nose clear. Palate is complete. Dentition normal for age. Tonsils small and non-inflamed bilaterally."] [text size=80 default="Lymph Nodes: No significant lymphadenopathy."] [text size=80 default="Thyroid: No thyromegaly; trachea midline without masses."] [text size=80 default="Breasts: Without lesions or drainage."] [text size=80 default="Heart: Regular rate and rhythm; normal S1 and S2; no murmurs, gallops, or rubs. "] [text size=80 default="Lungs: Unlabored respirations; symmetric chest expansion; clear breath sounds; no wheezes, crackles, rales, rhonchi, or retractions."] [text size=80 default="Abdomen: Soft, without organomegaly. Bowel sounds normal. Non-tender without rebound. No masses palpable. No distention."] [text size=80 default="Genitalia: Normal male external genitalia; testes descended bilaterally; no hernia."] [text size=80 default="Spine: Straight with no lesions."] [text size=80 default="Joints: Full range of motion about all joints."] [text size=80 default="Extremities: Peripheral pulses are equal. There is no clubbing, cyanosis or edema of the extremities. Capillary refill is less than 2 seconds."] [text size=80 default="Gait: Normal and appropriate gait for age."] [text size=80 default="Mental Status: Alert, oriented, in no distress. Appropriate for age."] [text size=80 default="Neuro: Normal reflexes; normal tone; no focal deficits appreciated. Appropriate for age."] [/conditional][conditional field="Q1|Q2" condition="((Q1).is('5-6 year')||(Q1).is('7-8 year')||(Q1).is('9-10 year')||(Q1).is('11-14 year')||(Q1).is('15-17 year')||(Q1).is('18-21 year'))&&((Q2).is('female'))"] [text size=80 default="General: Child appears age appropriate. Vitals noted and stable."] [text size=80 default="Skin: Normal turgor and without lesions."] [text size=80 default="Head: Normocephalic."] [text size=80 default="Eyes: Conjunctivae noninjected; sclerae anicteric; lids without ptosis, edema, or erythema; extraocular movements intact; pupils equal, round, and reactive to light. Symmetric light reflex, normal fundi."] [text size=80 default="ENT: TMs gray, sharp landmarks, mobile. Nose clear. Palate is complete. Dentition normal for age. Tonsils small and non-inflamed bilaterally."] [text size=80 default="Lymph Nodes: No significant lymphadenopathy."] [text size=80 default="Thyroid: No thyromegaly; trachea midline without masses."] [text size=80 default="Breasts: Without lesions or drainage."] [text size=80 default="Heart: Regular rate and rhythm; normal S1 and S2; no murmurs, gallops, or rubs. "] [text size=80 default="Lungs: Unlabored respirations; symmetric chest expansion; clear breath sounds; no wheezes, crackles, rales, rhonchi, or retractions."] [text size=80 default="Abdomen: Soft, without organomegaly. Bowel sounds normal. Non-tender without rebound. No masses palpable. No distention."] [text size=80 default="Genitalia: Normal female external genitalia."] [text size=80 default="Spine: Straight with no lesions."] [text size=80 default="Joints: Full range of motion about all joints."] [text size=80 default="Extremities: Peripheral pulses are equal. There is no clubbing, cyanosis or edema of the extremities. Capillary refill less than 2 seconds."] [text size=80 default="Gait: Normal and appropriate gait for age."] [text size=80 default="Mental Status: Alert, oriented, in no distress. Appropriate for age."] [text size=80 default="Neuro: Normal reflexes; normal tone; no focal deficits appreciated. Appropriate for age."] [/conditional] ASSESSMENT/PLAN: [conditional field="PEsports" condition="(PEsports).is('Sports Eval')"]#PRE-PARTICIPATION SPORTS EVALUATION Z02.5 -Neuro considerations- [checkbox value="no concerns|epilepsy in hx/fmhx|hx of concussion|conditions stable|warrants further eval"] -BH considerations- [checkbox value="no concerns|euthymic|low-risk|warrants further eval"] -BMI & Eating d/o screening- [checkbox value="no concerns|underweight|concern for possible eating disorder|overweight|obese|discussed nutrition & exercise|warrants further eval"] -Cardiovasc considerations- [checkbox value="no concerns|EKG performed and normal|physiologic murmur|concerning murmur|warrants further eval"] -Pulmonary considerations- [checkbox value="no concerns|asthma hx|well-controlled|uncontrolled|has rescue inhaler|rescue inhaler rx'd|discussed appropriate use of inhaler|needs PFT|warrants further eval"] -Ortho/MSK considerations- [checkbox value="no concerns|evidence of previous injuries|previous injuries appear well healed and stable|concern for scoliosis|concern for instability of joint(s)|warrants further eval"] -Hematologic concerns- [checkbox value="no concerns|sickle cell fmhx|sickle cell trait present|sickle cell disease|possible bleeding d/o in fmhx|warrants further eval"] -Overall Assessment: [select value="Low risk. Cleared for participation in selected sport|Not cleared for participation selected sport|Needs further workup prior to clearance for selected sport"] -Recommendations for further eval/workup: [checkbox value="no further eval needed|metabolic labs for obesity|Neuro referral|BH referral|EKG referral|EchoCG ordered|Cards referral|Pulm referral|PFT ordered|Ortho/SM referral|labs checking for sickle cell|labs checking for bleeding disorders"] -Education: [checkbox value="discussed risk of harm from identified health conditions with participation in certain sports|discussed avoidance of texting while driving|discussed avoidance of drug and alcohol use|discussed prevention of obesity|discussed eating disorders|discussed depression and suicidality|discussed bullying (especially online)|discussed sexual activity and contraception/STI prevention"] -Disposition: [checkbox value="no routine f/u needed|f/u with PCM regarding chronic health issues identified|f/u for re-evaluation for sports participation after completing above workup"] [checkbox name="sportscontralist" memo="List of contraindications for sports participation" memo_size="small" value=""] [/conditional][conditional field="sportscontralist" condition="(sportscontralist).is('')"][comment memo="-Active myocarditis or pericarditis -Hypertrophic cardiomyopathy -Severe hypertension until controlled by therapy (static resistance activities, such as weight lifting, are particularly contraindicated) -Suspected coronary artery disease until fully evaluated (patients with impaired resting left ventricular systolic function less than 50%, or exercise-induced ventricular dysrhythmias, or exercise-induced ischemia on exercise stress testing are at greatest risk of sudden death) -Long QT interval syndrome -History of recent concussion and symptoms of postconcussion syndrome (no contact or collision sports) -Poorly controlled convulsive disorder (no archery, riflery, swimming, weight lifting or power lifting, strength training or sports involving heights) -Recurrent episodes of burning upper-extremity pain or weakness, or episodes of transient quadriplegia until stability of cervical spine can be assured (no contact or collision sports) -Sickle cell disease (no high-exertion, contact or collision sports) -Eating disorder where athlete is not compliant with therapy and follow-up, or where there is evidence of diminished performance or potential injury because of eating disorder -Acute enlargement of spleen or liver" memo_size="small"][/conditional][conditional field="PEwellvisit" condition="(PEwellvisit).is('Well Visit')"]#Wellness Visit [comment memo="Z00.129 peds well with no new abnormals found Z00.121 peds well with NEW abnormals Z02.0 peds school/preschool physical " memo_size="small" memo_color="lightgreen"][checkbox value="-Normal growth and development. "][checkbox value="-Approved for all routine preventive medicine services, including immunizations "][checkbox value="-Abuse/neglect, functional status, nutrition and pain assessed and no further evaluation is needed. "][comment memo="Vaccination status/discussion" memo_size="small"][checkbox value="-Recommended immunization schedule reviewed and discussed, including side effects, risks, and benefits of immunizations. "][checkbox value=" -Patient uptodate. "][checkbox value=" -Patient NOT uptodate. "][checkbox value=" -Immunizations per recommended schedule to be given today. "][checkbox value=" -No immunizations to be given today. "][checkbox value=" -Parent/patient agreed to recommended catchup immunizations today. "][checkbox value=" -Parent/patient declined recommended immunizations today (will continue to address hesistancy at next visit) "][/conditional][conditional field="Q1" condition="(Q1).is('3-5 day')"][comment memo="Relevant Immunizations: -Hep B vacc #1 at birth (offered today if not received) " memo_size="small" memo_color="lightgreen"][comment memo="anticipatory guidance " memo_size="small"]-Injury prevention, health promotion issues discussed including age specific guidance: [checkbox value=" -Social determinants of health -living situation and food security (community agencies, WIC/SNAP) -Tobacco exposure if applicable (800-QUIT-NOW) -Family/community support (asking for help) "][checkbox value=" -Parent/family health & well-being -resting when baby rests -spending time with other children and maintaing their routines "][checkbox value=" -Newborn behavior/care -sing/talk/read to baby, avoid TV and other digital media -help baby wake for feeding by patting/diaper change/undressing -calming baby with stroking head & gentle rocking -never hit or shake baby -checking temperature rectally (not skin/ear) -emergency preparedness plan (first aid kit, list of phone #s) -wash hands often, avoid crowds -avoid sun, use infant sunscreen "][checkbox value=" -Nutrition and feeding -weight gain -feeding strategies -holding, burping, hunger and satisfaction cues -breast/formula feeding guidance "][checkbox value=" -Safety -carseat safety -parental use of seatbelt -heatstroke prevention -safe sleep (back to sleep, crib guidance) -burn prevention (hot drinks, baths) "][comment memo="other specifics" memo_size="small"][checkbox value="-Advised return to clinic at 1 month of age, or sooner if concerns arise. "][/conditional][conditional field="Q1" condition="(Q1).is('1 month')"][comment memo="Relevant Immunizations: -Hep B vacc #2 at 1-2mo " memo_size="small" memo_color="lightgreen"][comment memo="anticipatory guidance " memo_size="small"]-Injury prevention, health promotion issues discussed including age specific guidance: [checkbox value=" -Social determinants of health -living situation and food security (community agencies, WIC/SNAP) -Tobacco exposure if applicable (800-QUIT-NOW) -mold/radon/pesticides (check home, avoid use) -intimate partner violence (800-799-SAFE) -alcohol/substance abuse (avoidance) -family/community support (childcare) "][checkbox value=" -Parent/family health & well-being -arranging postpartum checkup -maternal depression/anxiety prevalence (self-care, when to seek help) -family relationships (time with partner) "][checkbox value=" -Infant behavior/development -put in crib when awake/drowsy -pacifier use -calming baby with stroking head & gentle rocking -never hit or shake baby -avoid TV/digital media with baby -start 'tummy time' when awake -take temperature rectally (not by skin/ear) -wash hands often, avoid crowds -avoid sun, use infant sunscreen "][checkbox value=" -Nutrition and feeding -feeding plans/choices -breast/formula feeding guidance "][checkbox value=" -Safety -carseat safety -parental use of seatbelt -safe sleep -preventing falls -choking/strangulation hazards -emergency care "][comment memo="other specifics" memo_size="small"][checkbox value="-Advised return to clinic at 2 months of age, or sooner if concerns arise. "][/conditional][conditional field="Q1" condition="(Q1).is('2 month')"][comment memo="Relevant Immunizations: -Hep B vacc #2 at 1-2mo -Rotavirus #1 at 2mo -DTaP #1 at 2mo -Hib #1 at 2mo -PCV13 #1 at 2mo -IPV #1 at 2mo " memo_size="small" memo_color="lightgreen"][comment memo="anticipatory guidance " memo_size="small"]-Injury prevention, health promotion issues discussed including age specific guidance: [checkbox value=" -Social determinants of health -living situation and food security (community agencies, WIC/SNAP) -family support (handling unwanted advice) -childcare (choosing quality childcare, recognizing difficulty of separation) "][checkbox value=" -Parent/family health & well-being -arranging postpartum checkup & family planning -maternal depression/anxiety prevalence (self-care, when to seek help) -family relationships (time with other children) "][checkbox value=" -Infant behavior/development -hold/cuddle/talk/sing to baby -learn baby's temperment, personality -attention to baby's cues for sleep, put down when awake/drowsy -schedule naps and nighttime sleep -avoid TV/digital media with baby -start 'tummy time' when awake -calm baby - stroking head, gentle rocking, walking in stroller -never hit or shake baby "][checkbox value=" -Nutrition and feeding -breast/formula feeding guidance -delaying solid foods -hunger and satiety cues "][checkbox value=" -Safety -carseat safety -parental use of seatbelt -safe sleep -burn prevention (hot drinks, baths) -preventing falls -drowning prevention "][comment memo="other specifics" memo_size="small"][checkbox value="-Advised return to clinic at 4 months of age, or sooner if concerns arise. "][/conditional][conditional field="Q1" condition="(Q1).is('4 month')"][comment memo="Relevant Immunizations: -Rotavirus #2 at 4mo -DTaP #2 at 4mo -Hib #2 at 4mo -PCV13 #2 at 4mo -IPV #2 at 4mo " memo_size="small" memo_color="lightgreen"][comment memo="anticipatory guidance " memo_size="small"]-Injury prevention, health promotion issues discussed including age specific guidance: [checkbox value=" -Social determinants of health -environment risk (lead) -maintaining social contacts and family relationships -childcare (choosing quality childcare) "][checkbox value=" -Infant behavior/development -continue calming strategies when baby fussy -spending time talking/playing with baby -create daily routine for feeding/naps/bedtime -avoid TV/digital media with baby -use quiet (reading/singing) and active (tummy time) playtime -provide safe opportunities to explore "][checkbox value=" -Oral health -maternal oral health -teething/drooling -good oral hygiene (no bottle in bed, cleaning teeth) "][checkbox value=" -Nutrition and feeding -breast/formula feeding guidance -delaying solid foods -feeding choices -supplements and OTC medications "][checkbox value=" -Safety -carseat safety -parental use of seatbelt -safe sleep -burn prevention (hot drinks, baths) -preventing falls -drowning prevention -choking/suffocation hazards -avoiding infant walkers "][comment memo="other specifics" memo_size="small"][checkbox value="-Advised return to clinic at 6 months of age, or sooner if concerns arise. "][/conditional][conditional field="Q1" condition="(Q1).is('6 month')"][comment memo="Relevant Immunizations: -Heb B #3 at 6-18mo -Rotavirus #3 at 6mo -DTaP #3 at 6mo -Hib #3 at 6mo -PCV13 #3 at 6mo -IPV #3 at 6-18mo -Influenza annual (seasonal) " memo_size="small" memo_color="lightgreen"][comment memo="anticipatory guidance " memo_size="small"]-Injury prevention, health promotion issues discussed including age specific guidance: [checkbox value=" -Social determinants of health -living situation and food security (community agencies, WIC/SNAP) -Tobacco exposure if applicable (800-QUIT-NOW) -alcohol/substance abuse (avoidance) -parental depression (how to get help) -family/community support (depending on social network) -childcare (trusted, responsible provider) "][checkbox value=" -Infant behavior/development -use high chair or upright seat so baby can see you -interactive/reciprocal play (talk/sing/read, play games) -avoid TV/digital media with baby -continue daily routines -continue calming strategies when baby fussy "][checkbox value=" -Oral health -fluoride source -good oral hygiene (no bottle in bed, cleaning teeth) -avoiding baby foods that baby sucks out of a bag -don't share spoons, don't clean pacifier in your mouth "][checkbox value=" -Nutrition and feeding -breast/formula feeding guidance -solid foods (introduce one at a time, iron-rich) -pesticides (wash fruits/vegetables) -limit juice to 2-4oz/day "][checkbox value=" -Safety -carseat safety -parental use of seatbelt -safe sleep -burn prevention (hot drinks, baths) -preventing falls -drowning prevention -choking/suffocation hazards -avoiding infant walkers "][comment memo="other specifics" memo_size="small"][checkbox value="-Advised return to clinic at 9 months of age, or sooner if concerns arise. "][/conditional][conditional field="Q1" condition="(Q1).is('9 month')"][comment memo="Relevant Immunizations: -Heb B #3 at 6-18mo " memo_size="small" memo_color="lightgreen"][comment memo="anticipatory guidance " memo_size="small"]-Injury prevention, health promotion issues discussed including age specific guidance: [checkbox value=" -Social determinants of health -intimate partner violence (800-799-SAFE) -make time for self, partner, and social contacts "][checkbox value=" -Infant behavior/development -consistent daily routines -provide opportunities for safe exploration -be realistic about abilities -recognize new social skills, separation anxiety, sensitive to temperament -play cause-and-effect toys; talk/sing/read together; respond to baby's cues -avoid TV, videos, computers; making a family media use plan "][checkbox value=" -Discipline -consistent positive discipline (limit 'no', use distraction, be role model) "][checkbox value=" -Nutrition and feeding -self-feeding -mealtime routines -transition to solid foods (table food introduction) -encourage cup drinking -plans for weaning (continue breastfeeding if mutually desired) "][checkbox value=" -Safety -carseat safety -parental use of seatbelt -heatstroke prevention -firearms safety -home safety check (stair gates, barriers around space heaters cleaning products electric cords) -burn prevention (hot liquids) -poisonings (poison help # 800-222-1222) -preventing falls (operable window guards) -drowning prevention ('touch supervision' near water, pools, bathtubs) "][comment memo="other specifics" memo_size="small"][checkbox value="-Advised return to clinic at 12 months of age, or sooner if concerns arise. "][/conditional][conditional field="Q1" condition="(Q1).is('12 month')"][comment memo="Relevant Immunizations: -Heb B #3 at 6-18mo -Hib #4 at 12-15mo -PCV13 #4 at 12-15mo -IPV #3 at 6-18mo -Influenza annual (seasonal, 2 doses 4wks apart if first immunization for 6mo-8yr olds) -MMR #1 at 12-15mo -Varicella #1 at 12-15mo -Hep A #1 at 12-23mo (#2 6mo later) " memo_size="small" memo_color="lightgreen"][comment memo="anticipatory guidance " memo_size="small"]-Injury prevention, health promotion issues discussed including age specific guidance: [checkbox value=" -Social determinants of health -living situation & food security (WIC/SNAP) -tobacco, EtOH, drugs (800-QUIT-NOW) -discuss with childcare giver childs needs (medical, feelings about diet, discipline, oral health, physical activity, media use) -maintain ties with friends, community "][checkbox value=" -Establishing routines -positive discipline, time-outs, distractions, praise for good behaviors -carve out family time daily, consistent daily routines -continue 1 nap aday, nightly bedtime routine with quiet time, reading, singing, favorite toy -establish teeth-brushing routine -avoid TV and other digital media with toddler, family media use plan "][checkbox value=" -Feeding and appetite changes -encourage self-feeding, avoid small hard foods -healthy food and snacks, encourage caregivers follow this also -3 meals and 2-3 snacks daily, toddlers tend to graze, trust child to decide how much to eat "][checkbox value=" -Establishing a dental home -dentist visit by 12 months of age or after first tooth erupts -brush teeth 2x/day with small smear of toothpast, soft toothbrush -if still using bottle, offer only water in bottle (avoid added sugar) "][checkbox value=" -Safety -carseat safety -falls prevention (stair gates, furniture away from windows, window guards) -drowning prevention ('touch supervision' near water, empty buckets pools bathtubs immediately after use) -sun protection (hat and clothing, sunscreen, avoid prolonged exposure 11am-3pm) -pets (keep child away from pet feeding area, monitor child/pet interactions) -poisoning (remove/lockup poisons & toxic household products, poison # 800-222-1222) "][comment memo="other specifics" memo_size="small"][checkbox value="-Advised return to clinic at 15 months of age, or sooner if concerns arise. "][/conditional][conditional field="Q1" condition="(Q1).is('15 month')"][comment memo="Relevant Immunizations: -Heb B #3 at 6-18mo -DtaP #4 at 15-18mo -Hib #4 at 12-15mo -PCV13 #4 at 12-15mo -IPV #3 at 6-18mo -Influenza annual (seasonal, 2 doses 4wks apart if first immunization for 6mo-8yr olds) -MMR #1 at 12-15mo -Varicella #1 at 12-15mo -Hep A #1 at 12-23mo (#2 6mo later) " memo_size="small" memo_color="lightgreen"][comment memo="anticipatory guidance " memo_size="small"]-Injury prevention, health promotion issues discussed including age specific guidance: [checkbox value=" -Communication and social development -allow child to choose between 2 options acceptable to you (when possible) -stranger anxiety, separation anxiety (these reflect new cognitive gains), speaking reassuringly -take time for self, partner, seek support from other parents -use simple, clear words/phrases to promote language development "][checkbox value=" -Sleep routines and issues -consistent bedtime and nighttime routine, tuck in when drowsy/awake -if night waking, reassure briefly -no bottle in bed, no TV/computer/digital device in child's bedroom "][checkbox value=" -Temperament, development, behavior, discipline -modify child's environment to avoid conflict/tantrums -use distractions, accept messiness, allow child to choose (when appropriate) -praise good behavior and accomplishments -use discipline for teaching/protecting (not punishing) -use time-outs to avoid negative attention -teach not to hit, bite, use aggressive behavior (model this as parent) "][checkbox value=" -Healthy teeth -schedule dentist visit if hasn't seen dentist yet -brush teeth 2x/day with small smear of toothpast, soft toothbrush -preent tooth decay with good family oral health habits (brushing, flossing) -not sharing utensils -if nighttime bottle, use water only "][checkbox value=" -Safety -carseat safety -ensure everyone uses seat belt -poisoning (remove poisons & toxic household products, poison # 800-222-1222) -falls prevention (stair gates, furniture away from windows, window guards) -install smoke detector on every level, test monthly, change batteries annually, fire escape plan, set home hot water <120F "][comment memo="other specifics" memo_size="small"][checkbox value="-Screened for Tuberculosis Risk (Close contact with person with TB, live in area where TB is common, recent immigrant?) - low risk. "][checkbox value="-Advised return to clinic at 18 months of age, or sooner if needed. "][/conditional][conditional field="Q1" condition="(Q1).is('18 month')"][comment memo="Relevant Immunizations: -Heb B #3 at 6-18mo -DtaP #4 at 15-18mo -Hib #4 at 12-15mo -PCV13 #4 at 12-15mo -IPV #3 at 6-18mo -Influenza annual (seasonal, 2 doses 4wks apart if first immunization for 6mo-8yr olds) -MMR #1 at 12-15mo -Varicella #1 at 12-15mo -Hep A #1 at 12-23mo (#2 6mo later) " memo_size="small" memo_color="lightgreen"][comment memo="anticipatory guidance " memo_size="small"]-Injury prevention, health promotion issues discussed including age specific guidance: [checkbox value=" -Social determinants of health -living situation & food security (WIC/SNAP) -tobacco, EtOH, drugs (800-QUIT-NOW) -discuss with childcare giver childs needs (medical, feelings about diet, discipline, oral health, physical activity, media use) -maintain ties with friends, community "][checkbox value=" -Establishing routines -positive discipline, time-outs, distractions, praise for good behaviors -carve out family time daily, consistent daily routines -continue 1 nap aday, nightly bedtime routine with quiet time, reading, singing, favorite toy -establish teeth-brushing routine -avoid TV and other digital media with toddler, family media use plan "][checkbox value=" -Feeding and appetite changes -encourage self-feeding, avoid small hard foods -healthy food and snacks, encourage caregivers follow this also -3 meals and 2-3 snacks daily, toddlers tend to graze, trust child to decide how much to eat "][checkbox value=" -Establishing a dental home -dentist visit by 12 months of age or after first tooth erupts -brush teeth 2x/day with small smear of toothpast, soft toothbrush -if still using bottle, offer only water in bottle (avoid added sugar) "][checkbox value=" -Safety -carseat safety -falls prevention (stair gates, furniture away from windows, window guards) -drowning prevention ('touch supervision' near water, empty buckets pools bathtubs immediately after use) -sun protection (hat and clothing, sunscreen, avoid prolonged exposure 11am-3pm) -pets (keep child away from pet feeding area, monitor child/pet interactions) -poisoning (remove/lockup poisons & toxic household products, poison # 800-222-1222) "][comment memo="other specifics" memo_size="small"][checkbox value="-Screened for Tuberculosis Risk (Close contact with person with TB, live in area where TB is common, recent immigrant?) - low risk. "][checkbox value="-Advised return to clinic at 2 years of age, or sooner if needed. "][/conditional][conditional field="Q1" condition="(Q1).is('2 year')"][comment memo="Relevant Immunizations: -Influenza annual (seasonal, 2 doses 4wks apart if first immunization for 6mo-8yr olds) -Hep A #1 at 12-23mo (#2 6mo later) " memo_size="small" memo_color="lightgreen"][comment memo="anticipatory guidance " memo_size="small"]-Injury prevention, health promotion issues discussed including age specific guidance: [checkbox value=" -Social determinants of health -intimate partner violence (800-799-SAFE) -living situation & food security (WIC/SNAP) -tobacco, EtOH, drugs (800-QUIT-NOW) -maintain social contacts, take care of self -create opportunities for family time -spend time with each child -not allowing hitting/biting/aggressive behavior, modeling this "][checkbox value=" -Temperament and behavior -praise good behavior, listen to and respect child -help child express feelings like joy, anger, sadness, frustration -encourage self-expression -learn child's way fo reacting to people/situations -encourage free play up to 60min/day, age-appropriate play equipment -make time for learning through reading, talking, singing, exploring -limit TV and other screens to no more than 1hr/day, avoid TV during meals "][checkbox value=" -Assessment of language development -model appropriate language -should be able to follow 1-2 step commands -read/look at books together daily, child may want same story over and over "][checkbox value=" -Toilet training -begin when ready (dry for 2hr periods, knows wet/dry, can pull pants up/down, can indicate BM) -plan for frequent toilet breaks (up to 10x/day) -teach to wash hands "][checkbox value=" -Safety -carseat safety, everyone else using seat belt -supervise outside, especially around cars/machinery/streets -use bike helmet -firearms safety (remove from home or store unloaded/locked/ammo separated) "][comment memo="other specifics" memo_size="small"][checkbox value="-Screened for Tuberculosis Risk (Close contact with person with TB, live in area where TB is common, recent immigrant?) - low risk. "][checkbox value="-Screened for Lead Poisoning Risk (house older than 1950) - low risk "][checkbox value="-Advised return to clinic at 2.5 years of age (30mo), or sooner if concerns arise. "][/conditional][conditional field="Q1" condition="(Q1).is('2.5 year (30mo)')"][comment memo="Relevant Immunizations: -Influenza annual (seasonal, 2 doses 4wks apart if first immunization for 6mo-8yr olds) -Hep A #1 at 12-23mo (#2 6mo later) " memo_size="small" memo_color="lightgreen"][comment memo="anticipatory guidance " memo_size="small"]-Injury prevention, health promotion issues discussed including age specific guidance: [checkbox value=" -Family routines -day and evening routines -enjoyable family activities -parental activities outside the family -consistency in the child's environment "][checkbox value=" -Language promotion and communication -Read together daily; go to the library -Listen when child speaks; repeat, using correct grammar "][checkbox value=" -Promoting social development -Encourage play with other children, but supervise because child not ready yet to share/play cooperatively -Build independence by offering choices between 2 acceptable alternatives -Limit TV and digital media to no more than 1 hour a day; monitor what child watches "][checkbox value=" -Preschool considerations -Consider group child care, preschool program, organized playdates or playgroups -Encourage toilet training success by: dressing child in easy-to-remove clothes; establish daily routine; place on potty every 1-2 hrs; praise; relaxed environment "][checkbox value=" -Safety -Carseat safety, everyone else using seat belt -Supervise outside, especially around cars/machinery/streets -Provide 'touch supervision' near water, bathtubs, pools, toilet -Use hat/sun protection clothing, sunscreen -Avoid prolonged exposure when sun is strongest, between 11:00 am and 3:00 pm -Install smoke detectors on every level; test monthly; change batteries annually -Fire escape plan; keep matches/hot objects out of sight/away from child "][comment memo="other specifics" memo_size="small"][checkbox value="-Screened for Tuberculosis Risk (Close contact with person with TB, live in area where TB is common, recent immigrant?) - low risk. "][checkbox value="-Screened for Lead Poisoning Risk (house older than 1950) - low risk "][checkbox value="-Advised return to clinic at 3 years of age, or sooner if concerns arise. "][/conditional][conditional field="Q1" condition="(Q1).is('3 year')"][comment memo="Relevant Immunizations: -Influenza annual (seasonal, 2 doses 4wks apart if first immunization for 6mo-8yr olds) -Hep A #1 at 12-23mo (#2 6mo later) " memo_size="small" memo_color="lightgreen"][comment memo="anticipatory guidance " memo_size="small"]-Injury prevention, health promotion issues discussed including age specific guidance: [checkbox value=" -Social determinants of health -living situation & food security (WIC/SNAP) -tobacco, EtOH, drugs (800-QUIT-NOW) -Show affection in family; handle anger constructively; give child opportunities to make choices -Take time for self, partner; create opportunities for family to spend time with the child "][checkbox value=" -Playing with siblings and peers -Encourage play with appropriate toys and safe exploration; expect fantasy play -Encourage interactive games with peers; explain importance of taking turns -Help your children develop good relations with each other "][checkbox value=" -Encouraging literacy activities -Read, sing, play rhyme games together; let child 'tell' story; practice reading wherever you go -Encourage child to talk about friends, experiences "][checkbox value=" -Promoting healthy nutrition and physical activity -Always have cool water available -Provide 16 to 24 oz low-fat/fat-free milk daily -Juice is not a necessary drink. Limit to 4 oz daily and always serve it with a meal -Offer variety of healthy foods/snacks, especially vegetables, fruits, lean protein -Trust child to decide how much to eat -Encourage opportunities for physical activity for child, family -Limit TV and other digital media to no more than 1 hour a day -Monitor what child watches; consider making a family media use plan "][checkbox value=" -Safety -Carseat safety, everyone else using seat belt -Prevent choking by cutting food into small pieces -Supervise all play near streets/driveways; don’t allow child to cross street alone -Move furniture away from windows; install operable window guards -Provide 'touch supervision' near water, bathtubs, pools, toilet -Teach child about safety around pets -Firearms safety (remove from home or store unloaded/locked/ammo separated) "][comment memo="other specifics" memo_size="small"][checkbox value="-Screened for Tuberculosis Risk (Close contact with person with TB, live in area where TB is common, recent immigrant?) - low risk. "][checkbox value="-Screened for Lead Poisoning Risk (house older than 1950) - low risk "][checkbox value="-Advised return to clinic at 4 years of age, or sooner if concerns arise "][/conditional][conditional field="Q1" condition="(Q1).is('4 year')"][comment memo="Relevant Immunizations: -DtaP #5 at 4-6yr -IPV #4 at 4-6yr -Influenza annual (seasonal, 2 doses 4wks apart if first immunization for 6mo-8yr olds) -MMR #2 at 4-6yr -Varicella #2 at 4-6yr " memo_size="small" memo_color="lightgreen"][comment memo="anticipatory guidance " memo_size="small"]-Injury prevention, health promotion issues discussed including age specific guidance: [checkbox value=" -Social determinants of health -living situation & food security (WIC/SNAP) -tobacco, EtOH, drugs (800-QUIT-NOW) -intimate partner violence (800-799-SAFE) -Teach child rules for being safe with adults: (1) no adult should tell a child to keep secrets from parents (2) no adult should express interest in private parts (3) no adult should ask a child for help with his/her private parts -Maintain or expand participation in community activities "][checkbox value=" -School readiness -Give child time to finish sentences; encourage speaking skills by reading/talking together; keep answers short and simple -Read together daily; ask child questions about the stories -Children are very sensitive, either easily encouraged or hurt -Model respectful behavior and apologize if wrong -Praise when demonstrates sensitivity to feelings of others -Provide opportunities for your child to play with other children -Visit child’s preschool/child care program; become actively involved; talk with child about what they are learning "][checkbox value=" -Developing healthy nutrition and personal habits -Always have cool water available -Provide 16 to 24 oz low-fat/fat-free milk daily -Juice not a necessary drink. Limit to 4 oz daily and always serve it with a meal -Offer variety of healthy foods/snacks, especially vegetables, fruits, lean protein -Trust child to decide how much to eat -Create calm bedtime ritual; enjoy mealtimes without TV -Ensure child brushes teeth twice a day with fluoridated toothpaste "][checkbox value=" -Media use -Limit TV and video to no more than 1 hour a day; no TV in bedroom -Supervise any Internet use; consider making a family media use plan -Make opportunities for daily play; be physically active as a family "][checkbox value=" -Safety -Carseat safety, everyone else using seat belt -Supervise all outdoor play; never leave child alone; don’t allow to cross street alone -Be sure swimming pools are fenced; use life jacket; teach child to swim -Use hat/sun protection clothing, sunscreen -Avoid prolonged exposure when sun is strongest, between 11:00 am and 3:00 pm -Teach child about safety around pets -Firearms safety (remove from home or store unloaded/locked/ammo separated) "][comment memo="other specifics" memo_size="small"][checkbox value="-Advised return to clinic in one year or sooner if concerns arise "][/conditional][conditional field="Q1" condition="(Q1).is('5-6 year')"][comment memo="Relevant Immunizations: -DtaP #5 at 4-6yr -IPV #4 at 4-6yr -Influenza annual (seasonal, 2 doses 4wks apart if first immunization for 6mo-8yr olds) -MMR #2 at 4-6yr -Varicella #2 at 4-6yr " memo_size="small" memo_color="lightgreen"][comment memo="anticipatory guidance " memo_size="small"]-Injury prevention, health promotion issues discussed including age specific guidance: [checkbox value=" -Social determinants of health -Teach child nonviolent conflict-resolution techniques -Talk with parents/trusted adult if bullied -living situation & food security (WIC/SNAP) -tobacco, EtOH, drugs (800-QUIT-NOW) -Encourage independence, self-responsibility; show affection; praise appropriately -Spend time with child; make time to talk "][checkbox value=" -Development and mental health -Continue family routines; assign household chores -Use discipline for teaching, not punishment -Model anger management/self-discipline -Solve conflict/anger by talking, going outside and playing, walking away "][checkbox value=" -School -Ensure child is ready to learn (regular bedtime routine, healthy breakfast) -Tour school; attend back-to-school events -Be sure after-school care is safe, positive -Talk with child about school experiences -If child has special health care needs, be active in IEP process "][checkbox value=" -Physical growth and development -Help child with brushing teeth if needed -Visit dentist twice a year -Brush teeth twice a day; floss once -Help child choose healthy eating (provide healthy foods, eat together as a family, be a role model) -Eat breakfast; eat vegetables/fruits -Eat when hungry; stop when satisfied -Drink milk 2 to 3 times a day -Limit sugary drinks/foods -Consider making family media use plan -Be physically active often during the day "][checkbox value=" -Safety -Use properly positioned belt-positioning booster seat in backseat -Teach safe street habits (crossing/riding school bus) -Ensure child uses safety equipment (helmet, pads) -Teach child to swim; supervise around water -Use sunscreen; wear hat -Avoid prolonged exposure when sun is strongest, between 11:00 am and 3:00 pm. -Teach child rules for being safe with adults: (1) no adult should tell a child to keep secrets from parents (2) no adult should express interest in private parts (3) no adult should ask a child for help with his/her private parts -Install smoke detectors and carbon monoxide detector/alarms; make fire escape plan -Firearms safety (remove from home or store unloaded/locked/ammo separated) "][comment memo="other specifics" memo_size="small"][checkbox value="-Vision screening/acuity performed and unremarkable "][checkbox value="-Hearing screening performed and unremarkable "][checkbox value="-Hearing screening attempted but child uncooperative "][checkbox value="-Advised return to clinic in one year or sooner if concerns arise "][/conditional][conditional field="Q1" condition="(Q1).is('7-8 year')"][comment memo="Relevant Immunizations: -Influenza annual (seasonal, 2 doses 4wks apart if first immunization for 6mo-8yr olds) " memo_size="small" memo_color="lightgreen"][comment memo="anticipatory guidance " memo_size="small"]-Injury prevention, health promotion issues discussed including age specific guidance: [checkbox value=" -Social determinants of health -Teach child nonviolent conflict-resolution techniques -Talk with parents/trusted adult if bullied -Contact community resources, like SNAP, for help with food assistance -tobacco, EtOH, drugs (800-QUIT-NOW) -Put family computer in easily seen place; monitor computer use; install safety filter -Don’t give out personal information online -Encourage independence, self-responsibility; show affection; praise appropriately -Spend time with child; make time to talk; know child’s friends "][checkbox value=" -Development and mental health -Encourage competence/independence/self-responsibility -Discuss rules, consequences -Be positive role model; do not hit or let others hit -Talk about worries -Be aware of pubertal changes; answer questions simply "][checkbox value=" -School -Ensure child is ready to learn (regular bedtime routine, healthy breakfast) -Show interest in school and activities -If concerns, ask teacher about evaluation for special help/tutoring; help with bullying. -If child has special health care needs, be active in IEP process "][checkbox value=" -Physical growth and development -Take child to dentist twice a year -Give fluoride supplement if dentist recommends -Limit sweetened drinks/snacks -Brush teeth twice a day; floss once -Wear mouth guard during sports -Help child choose healthy eating (provide healthy foods, eat together as a family, be a role model) -Eat breakfast; eat vegetables/fruits -Eat when hungry; stop when satisfied -Drink milk 3 or more times a day -Limit sugary drinks/foods -Be physically active often during the day -Consider making family media use plan "][checkbox value=" -Safety -Use belt-positioning booster seat in backseat -Ensure child uses safety equipment (helmet, pads) -Be a role model and always wear a helmet -Teach child to swim; supervise around water -Use sunscreen; wear hat -Avoid prolonged exposure when sun is strongest, between 11:00 am and 3:00 pm -Know child’s friends; teach home safety rules for fire/emergencies -Teach child rules for being safe with adults: (1) no adult should tell a child to keep secrets from parents (2) no adult should express interest in private parts (3) no adult should ask a child for help with his/her private parts -Firearms safety (remove from home or store unloaded/locked/ammo separated) "][/conditional][conditional field="Q1" condition="(Q1).is('9-10 year')"][comment memo="Relevant Immunizations: -Influenza annual (seasonal, 2 doses 4wks apart if first immunization for 6mo-8yr olds) -HPV can start at 9yrs, routine 11-12yrs (2-shot series, #2 given 6-12mo later and no earlier 5mo later) optional at this age " memo_size="small" memo_color="lightgreen"][comment memo="anticipatory guidance " memo_size="small"]-Injury prevention, health promotion issues discussed including age specific guidance: [checkbox value=" -Social determinants of health -Teach child nonviolent conflict-resolution techniques -If concerns at school, ask for help from teacher/principal; discuss bullying -Talk with parents/trusted adult if bullied -Contact community resources like SNAP for help with food assistance -Don’t use tobacco/e-cigarettes; Call 800-QUITNOW (800-784-8669) for help to quit smoking -Put family computer in easily seen place; monitor computer use; install safety filter -Don’t give out personal information online -Encourage new opportunities, activities, helping out at home/in community -Spend time with your child; discuss changing responsibilities within family -Clearly communicate rules, expectations -Get to know child’s friends. -Making and keeping friends is an important life skill "][checkbox value=" -Development and mental health -Anticipate new adolescent behaviors, importance of peers -Reinforce values; encourage discussion of thoughts/feelings -Appropriate anger management; provide personal space at home -Be a role model for positive behavior -Supervise activities with peers. -Answer questions about puberty/sexuality; counsel to avoid sexual activity -Teach rules for being safe with adults: (1) no adult should tell a child to keep secrets from parents (2) no adult should express interest in private parts (3) no adult should ask a child for help with his/her private parts "][checkbox value=" -School -Show interest in school performance/activities; if concerns, ask teacher about extra help -Create quiet space for homework "][checkbox value=" -Physical growth and development -Visit dentist twice a year -Give fluoride supplements if dentist recommends -Brush teeth 2 minutes, twice a day; floss once. -Wear mouth guard during sports. -Help child choose healthy eating (provide healthy foods, eat together as a family, be a role model) -Eat breakfast; eat vegetables/fruits/whole grains/low-fat or nonfat dairy/lean protein -Eat when hungry; stop when satisfied -Limit foods/drinks high in sugar/saturated fats/refined grains -Talk with physician before trying to lose weight -Be physically active often during the day -Consider making family media use plan "][checkbox value=" -Safety -The backseat is the safest place to ride. Switch from booster seat to seat belt in rear seat when child is ready -Use safety equipment (helmets, pads) -Teach child to swim; supervise around water -Use sunscreen; wear hat -Avoid prolonged exposure when sun is strongest, between 11:00 am and 3:00 pm. -Know child’s friends; make plan for personal safety. -Firearms safety (remove from home or store unloaded/locked/ammo separated) "][comment memo="other specifics" memo_size="small"][checkbox value="-Vision screening/acuity performed and unremarkable "][checkbox value="-Hearing screening performed and unremarkable "][checkbox value="-Hearing screening attempted but child uncooperative "][checkbox value="-Advised return to clinic in one year or sooner if concerns arise "][/conditional][conditional field="Q1" condition="(Q1).is('11-14 year')"][comment memo="Relevant Immunizations: -Influenza annual (seasonal, 2 doses 4wks apart if first immunization for 6mo-8yr olds) -Tdap #1 at 11-12yrs -HPV can start at 9yrs, routine 11-12yrs (2-shot series, #2 given 6-12mo later and no earlier 5mo later) -MenACWY #1 at 11-12yrs (#2 at 16yrs) " memo_size="small" memo_color="lightgreen"][comment memo="anticipatory guidance " memo_size="small"]-Injury prevention, health promotion issues discussed including age specific guidance: [checkbox value=" -Social determinants of health -Learn to manage conflict nonviolently; walk away if necessary; Talk with parent/trusted adult if bullied -When dating or in sexual situations, no means NO; No is OK -Teach your child nonviolent conflict-resolution skills -Discuss Internet safety; explain expectations about time with friends/dating -Community agencies can help with concerns about living situation -Programs like SNAP are available for help with food situation -Don’t use tobacco/e-cigarettes; talk with physician if worried about family member drug/alcohol use -Spend time with your family; help out at home, in the community; follow family rules -Making and keeping friends is an important life skill -Take responsibility for schoolwork; talk with parent/trusted adult about problems at school -Pursue interests outside of school -Involve child in family decision-making; encourage to think through problems "][checkbox value=" -Physical growth and development -Brush teeth twice a day; floss once -Continue dentist visits; give fluoride if dentist recommends it -Support healthy self-image by praising activities/achievements, not appearance -Eat when hungry; stop when satisfied -Eat breakfast; eat vegetables/fruits/whole grains/lean protein -Have 24 oz or more low-fat/nonfat dairy/other dairy daily -Limit foods and drinks high in sugar/saturated fats/refined grains and low in nutrients -Drink water -Support healthy weight and help child choose healthy eating (provide healthy foods, eat together as a family, be a role model) -Be physically active 60 minutes a day -Use safety equipment during sports -Consider making family media use plan -Get enough sleep "][checkbox value=" -Emotional well-being -Find ways to deal with stress -Discussing concerns about child’s behavior, moods, mental health, or substance use -Recognize that hard times come and go; talk with parents/trusted adult -Get accurate information about physical development, sexuality and sexual feelings toward opposite or same sex; talk with physician/parents/trusted adults -Talk with child about the physical changes that occur during puberty, including menstruation for girls -Discussing questions about adolescent sexual development, sexual orientation, or gender identity "][checkbox value=" -Risk reduction -Don’t smoke/vape, drink alcohol, or use drugs; avoid situations with drugs/alcohol -Don’t share own or others’ prescription medications; support friends who don’t use; discussing concerns about own or a family member’s use. -Talk with your child about tobacco/alcohol/drugs; praise for not using; be a role model -The safest way to prevent pregnancy and STIs is to not have sex, including oral sex -Plan how to avoid risky situations; if sexually active, protect against STIs/pregnancy -Know child’s friends and activities; clearly discuss rules, expectations -Talk about relationships, sex, values -Encourage sexual abstinence; provide opportunities for safe activities -Wear hearing protection when exposed to loud noise (concerts, lawn mowing) -Keep earbud volume moderate "][checkbox value=" -Safety -Wear seat belt, helmet, protective gear, life jacket -Wear seat belt; don’t allow ATV riding -Use sunscreen; wear hat -Avoid prolonged sun exposure between 11:00 am and 3:00 pm -Don’t ride in car with person who has used alcohol/drugs; call parents/trusted adult for help -Help youth make plan for handling situation in which feels unsafe riding in a car -Remove firearms from home; if firearm necessary, store unloaded and locked, with ammunition locked separately "][comment memo="other specifics" memo_size="small"][checkbox value="-Vision screening/acuity performed and unremarkable "][checkbox value="-Hearing screening performed and unremarkable "][checkbox value="-Hearing screening attempted but child uncooperative "][checkbox value="-Advised return to clinic in one year or sooner if concerns arise "][/conditional][conditional field="Q1" condition="(Q1).is('15-17 year')"][comment memo="Relevant Immunizations: -Influenza annual (seasonal, 2 doses 4wks apart if first immunization for 6mo-8yr olds) -MenACWY #2 at 16yrs " memo_size="small" memo_color="lightgreen"][comment memo="anticipatory guidance " memo_size="small"]-Injury prevention, health promotion issues discussed including age specific guidance: [checkbox value=" -Social determinants of health -Learn to manage conflict nonviolently; walk away if necessary -Avoid risky situations; call for help if things get dangerous -When dating or in sexual situations, no means NO; No is OK. -Teach adolescent nonviolent conflict resolution skills; discuss Internet safety. -Community agencies can help with concerns about your living situation -Programs like SNAP available to help with concerns about food situation -Don’t use tobacco/e-cigarettes; talk with physician if worried about family member drug/alcohol use -Spend time with family; work with them to solve problems -Making and keeping friends is an important life skill -Spend time with/praise/be affectionate with adolescent; agree on limits, consequences; know where he and friends are; provide opportunities for independent decision-making. -Help adolescent follow interests to new activities; increase awareness of community issues/needs -Take responsibility for schoolwork; follow family rules; ask for help when needed -Find ways to deal with stress; talk with parents/trusted adult -Involve adolescent in family decision-making; encourage to think through problems and practice independent decision-making "][checkbox value=" -Physical growth and development -Brush teeth twice a day; floss once. -Continue dentist visits; give fluoride if dentist recommends. -Figure out the healthy eating/physical activity combination that will keep body strong and healthy. -Eat when hungry; stop when satisfied -Eat breakfast; eat vegetables/fruits/whole grains/lean protein -Have 24 oz or more low-fat/nonfat dairy/other dairy daily -Limit foods and drinks high in sugar/saturated fats/refined grains and low in nutrients -Drink water -Be physically active 60 minutes a day -Use safety equipment during sports -Get enough sleep -Support healthy self-image by praising activities/achievements, not appearance -Support healthy weight and help adolescent choose healthy eating (provide healthy foods, eat together as a family, be a role model) "][checkbox value=" -Emotional well-being -Recognize that hard times come and go; talk with parents/trusted adult -Talk with me about concerns for adolescent’s emotional well-being/mental health -Get accurate information about physical development as well as sexuality and sexual feelings toward opposite or same sex; talk with parents/trusted adults -Communicate often; share expectations clearly -Discussing questions about adolescent sexual development, sexual orientation, or gender identity "][checkbox value=" -Risk reduction -Don’t smoke/vape, drink alcohol, or use drugs; avoid situations with drugs/alcohol -Don’t share your own or others’ prescription medications; support friends who don’t use; talk with physician if concerned about family member’s use -Talk with adolescent about tobacco/alcohol/drugs; know youth’s friends and activities; clearly discuss rules/expectations; praise for not using -Be a role model; lock liquor cabinet; store prescription medicines in locked location -Abstaining from sexual intercourse, including oral sex, is the safest way to prevent pregnancy and STIs -Plan how to avoid sex, risky situations -If sexually active, protect against STIs and pregnancy by correctly/consistently using long-acting reversible contraception, such as IUD/contraceptive implant, or birth control pills; Use with a condom -Help adolescent make a plan for resisting pressure; help as accepts responsibility for her decisions and relationships -Wear hearing protection when exposed to loud noise (concerts, lawn mowing) -Keep earbud volume moderate "][checkbox value=" -Safety -Wear seat belt; don’t talk/text/use mobile device when driving -Wear helmet, protective gear, life jacket -Wear seat belt; don’t talk/text/use mobile device when driving -Use sunscreen; wear hat -Avoid prolonged sun exposure between 11:00 am and 3:00 pm; avoid tanning parlors -Remove firearms from home; if firearm necessary, store unloaded and locked, with ammunition locked separately "][comment memo="other specifics" memo_size="small"][checkbox value="-Vision screening/acuity performed and unremarkable "][checkbox value="-Hearing screening performed and unremarkable "][checkbox value="-Hearing screening attempted but child uncooperative "][checkbox value="-Advised return to clinic in one year or sooner if concerns arise "][/conditional]-Additional comments: [textarea default="none"] [comment memo="coding blurbs" memo_size="small"][checkbox value="-The above SocHx/Allergies/Meds/PMHx/PSHx/FMHx were reviewed & updated at today's visit. "][checkbox value="-The scribe/medic/nurse/student assisted in collecting and documenting the patient's history. -I have personally reviewed it and verified its accuracy. "][checkbox value="-The scribe/medic/nurse/student assisted in documenting the physical exam performed by me. -I have personally reviewed it and verified its accuracy. "][checkbox value="-Laboratory results as displayed were reviewed and interpreted "][checkbox value="-Radiologic study results as displayed were reviewed and interpreted "][checkbox value="-Radiologic study images which results are displayed in note were reviewed and interpreted "][link url="https://brightfutures.aap.org/Bright%20Futures%20Documents/BF4_POCKETGUIDE.pdf" memo=" Peds Anticipatory Guidance Guide (AAP)"][link url="https://www.aap.org/en-us/Documents/periodicity_schedule.pdf" memo=" Peds Prev Health Screening Schedule (AAP)"] [link url="https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html" memo=" Peds Immunizations Schedule (CDC)"] [comment memo="Adapted from original work by "][link url="https://www.soapnote.org/author/marnold2777/" memo="marnold2777"][comment memo=" at "][link url="https://www.soapnote.org/plan/pwf3pw-pe-ap-peds-well-visit-physician-workflow-template-3pw/" memo="https://www.soapnote.org/plan/pwf3pw-pe-ap-peds-well-visit-physician-workflow-template-3pw/"][comment memo="Arnold M. PWF3pw – PE/AP Peds Well & Sports Physical – Physician Workflow Part 3pw. The SOAPnote Project. https://www.soapnote.org/plan/pwf3pw-pe-ap-peds-well-visit-physician-workflow-template-3pw/. Published December 24, 2019. Updated February 15, 2020. Accessed July 1, 2020."]
Result - Copy and paste this output:
Sandbox Metrics: Structured Data Index 0.55, 423 form elements, 6 boilerplate words, 140 text boxes, 2 text areas, 168 checkboxes, 1 check lists, 5 drop downs, 5 links, 63 comments, 39 conditionals, 415 total clicks
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