Endo clinic – obesity

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Pediatric Endocrinology Consultant Addendum
Consultant: [textarea cols=40 rows=1 default="Dr."]
Date: [date] (M-D-Y)
I saw and evaluated the patient on the date of service with the fellow [textarea cols=15 rows=1 default="Dr."]. I was present during the history and exam. I reviewed the pertinent medical records, medications, vital signs, labs, and imaging. I discussed the assessment/plan with fellow/resident, the primary team, and provided counseling for the patient/family.
Patient accompanied by: [select name="Q1" value="mother|father|mother,father"][text default="_"]
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Contact info:
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Chief Complaint: [textarea cols=40 rows=1 default="Obesity"][comment memo="fill out"]
In Summary:
This is a [textarea cols=10 rows=1 default="_"] [select value="y/o|m/o"] [select value="F|M"] , [textarea cols=60 rows=1 default=" previously healthy. with _"].
The patient [select value="was referred to our clinic for evaluation of|is presenting to endocrine clinic for follow-up for"] [textarea cols=60 rows=1 default=" obesity. Last seen on _"].
Probelm list:
1.[textarea default="_"]
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Obesity pertinent clinical information:
*Risk factors:
[checklist value="sedentary lifestyle|excess caloric intake|high glycemic index food (sugar-containing beverages)|large portion sizes|fast food|prolonged screen time|shortened sleep duration or irregular sleep schedules|snoring or restless sleep|medication causing weight gain (steroid, etc)"]
-Family history:
[checklist value="family history of extreme obesity"][textarea cols=60 rows=1 default=", first-degree relative"]
[checklist value="cardiovascular disease| hypertension|diabetes|liver or gallbladder disease| respiratory problems (severe asthma or sleep apnea)"], [textarea cols=60 rows=1 default="first-degree relative"]
[textarea cols=60 rows=1 default="-Born FT_, BW: _kg."]
*features of syndromic/genetic obesity:
[checklist value="early-onset obesity (before 5yr)|developmental delay or intellectual disability| vision problems|deafness|history of hypotonia and feeding difficulties during infancy|hyperphagia"]
*BMI: [textarea cols=60 rows=1 default="_ kg/m2. Z score _."]
-BMI Classification
[checklist value=" Underweight:BMI <5th percentile|Healthy weight: BMI ≥5th to <85th percentile|Overweight: BMI ≥85th to <95th percentile|Class I obesity (mild):BMI ≥95th to <120% of the 95th percentile and <35 kg/m2|Class II obesity (extreme): BMI ≥120% to <140% of the 95th percentile or ≥35 kg/m2 (whichever is lower)|Class III obesity (extreme):BMI ≥140% of the 95th percentile or ≥40 kg/m2 (whichever is lower)"]
[link url="https://www.uptodate.com/contents/calculator-body-mass-index-bmi-percentiles-for-females-2-to-20-years?search=pediatric%20obesity&topicRef=5874&source=see_link" memo="Female calculator"][link url="https://www.uptodate.com/contents/calculator-body-mass-index-bmi-percentiles-for-males-2-to-20-years?search=pediatric%20obesity&topicRef=5874&source=see_link" memo="/ Male calculator"]
*Puberty: [select value="prepubertal|pubertal"]
[comment memo="will disappear"] [select name="Q11" value="Denies new puberty changes|Pubertal"] [conditional field="Q11" condition="(Q11).is('Pubertal')"] [textarea cols=65 rows=1 default="_Menarche at age_. Last menstrual period_."].[checkbox value="denies discharge or lesion|denies abnormal vaginal bleeding|denies amenorrhea|denies irregular monthly periods"][/conditional]
-ROS:
[checklist name="99" value="poor appetite/caloric intake|weight loss/poor weight gain|abdominal pain|nausea/vomiting|diarrhea|constipation|polyuria/polydipsia|heat or cold intolerance|skin/hair changes|easy brusing|headache|vision changes|fatigue|fever|arthralgia|rashes|psychytric issues"]
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PHYSICAL EXAM Findings [textarea cols=60 rows=1 default="( done in presence of _, with patient/guardian permission)"].
[checklist value="BP within normal for age/sex|High BP for age/sex"]
[link url="https://www.uptodate.com/contents/image?imageKey=PEDS%2F114638&topicKey=PEDS%2F2872&search=hypertension%20screening%20pediatric&source=outline_link&selectedTitle=1~71" memo="BP ranges"]
[checklist value="dysmorphic features|short stature|Red hair|Cushingoid fat distribution|Striae (>1cm)|acne|hirsutism|acanthosis"]
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Tanner stage:
-T[select value="1|2|3|4|5"] pubic hair
-T[select value="1|2|3|4|5"] [select value="breast|testes"] [textarea cols=60 rows=2 default="_no clitromegaly, _no micropenis. Rt: _ml, Lt: _ml"]
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Lab/imaging review and interpretation
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1.
2.
3. "]
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Obesity screening labs:
1. Lipid profile: [date] (M-D-Y)--[textarea cols=20 rows=1 default="ordered_. LDL borderline, TG high"]**screen once >2yrs, once between ages 9-11 ys, and once ages 17-21 years**
2. LFT:[date] (M-D-Y)--[textarea cols=20 rows=1 default="ordered_. high"]. ** screen starting between 9-11 yrs. If normal, repeat q2-3 yrs**
3. Fasting glucose, HbA1c, or oral glucose tolerance test: [date] (M-D-Y)--[textarea cols=20 rows=1 default="ordered_. prediabetes"]**screen if >=10yr +risk factors**
3. Kidney function (BUN and Cr): [date] (M-D-Y)--[textarea cols=20 rows=1 default="ordered_. normal"]
4. Urine for UACR: [date] (M-D-Y)--[textarea cols=20 rows=1 default="ordered_. normal"] **screen in severe obesity**
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IMPRESSION:
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#Obesity,
[checklist value="Gradual onset, progressive|Abrupt onset of weight gain|Severe early-onset"]
[textarea default="likely exogenous related to sedentary lifestyle with excess caloric intake. No clinical features to suggest endocrine or genetic/syndromic causes of obesity."]
#Obesity comorbidities:
[checklist value="none|elevated BP reading without diagnosis of hypertension|Hypertension|Hyperlipidemia, hypertriglyceridemia|Elevated LFT/Fatty liver disease|Type 2 DM or impaired glucose tolerance|sleep apnea|PCOS"]
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PLAN:
[textarea default="1-Lifestyle modification: Extensive education about healthy diet choices and importance of physical activity was discussed with the family.
2- Referral: dietitian for further counseling. ?sleep
3- Labs: No further screening indicated at this time.Lipid profile, A1C, CMP, TSH/FT4, Vitamin d. Urine A/CR
4- Imaging: none
5- Medication: none
6- Counseling: obesity and associated comorbidities
7- Follow-up with PCP for weight management 
8- Followup with me in 6 months."]
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[textarea default="Counseled family at length about our impression, and explained diagnosis, lab results, and management plan. All questions were fully answered. Family verbalized understanding and agreement with the plan of care."]