Health Maintenance Visit – Pediatrics

[link url="../../child-health/health-maintenance-visit/" memo="See also the updated version at this page  "]Subjective/History
[select name="Q1" value="1 week|2 month|4 month|6 month|9 month|12 month|15 month|2 year|3 year|4 year|5 year|6-10 year|11-14 year|15-18 year"][conditional field="Q1" condition="(Q1).is('1 week')"]
[text size=80 default="Has done well since hospital discharge. "]
[text size=80 default="Nursing/formula every 1-3 hours.  "]
[text size=80 default="Growth is normal. "]
[text size=80 default="Alert to sights and sounds. "]
[text size=80 default="No problems with urine or stool. "]
[text size=80 default="Quiets with comforting. "]
[text size=80 default="Sleeps on back. "]
[text size=80 default="Newborn screen pending/negative/***.  "]
[text size=80 default="All other systems are negative."][/conditional][conditional field="Q1" condition="(Q1).is('2 month')"]
[text size=80 default="Has done well over the past month. "]
[text size=80 default="Nutrition includes feeding/nursing every 2-3 hours/--- formula every 2-3 hours. "]
[text size=80 default="Growth is normal. "]
[text size=80 default="Alert to sights and sounds. Coos and smiles. Turns to sound. Holds object. Recognizes face. "]
[text size=80 default="No concerns regarding hearing. "]
[text size=80 default="No problems with urine or stool. "]
[text size=80 default="Sleeps on back. "]
[text size=80 default="Usual sleep pattern. "]
[text size=80 default="All other systems are negative."][/conditional][conditional field="Q1" condition="(Q1).is('4 month')"]
[text size=80 default="Has done well over the past two months. "]
[text size=80 default="Nutrition includes nursing/--- formula.  "]
[text size=80 default="Growth is normal. "]
[text size=80 default="Speech includes squealing and cooing. "]
[text size=80 default="No concerns regarding hearing. Responsive. Smiling. Reaches for objects. Hands to midline/mouth. Head up prone. Pivots while on stomach. "]
[text size=80 default="No problems with urine or stool. "]
[text size=80 default="Usual sleep pattern. "]
[text size=80 default="All other systems are negative."][/conditional][conditional field="Q1" condition="(Q1).is('6 month')"]
[text size=80 default="Has done well over the past two months. "]
[text size=80 default="Nutrition includes --- formula/nursing plus solids. "]
[text size=80 default="Growth is normal. "]
[text size=80 default="Speech includes squealing, cooing, and some repetitive sounds. "]
[text size=80 default="No concerns regarding hearing. "]
[text size=80 default="Motor skills include rolling, sitting, and transferring with both hands. Looks for object. Toes to mouth. "]
[text size=80 default="No problems with urine or stool. "]
[text size=80 default="No significant sleep issues. "]
[text size=80 default="No previous immunization reactions.  "]
[text size=80 default="All other systems are negative."][/conditional][conditional field="Q1" condition="(Q1).is('9 month')"]
[text size=80 default="Has done well over the past few months. "]
[text size=80 default="Nutrition includes formula feeding with ---/nursing
along with baby and table foods. "]
[text size=80 default="Growth is normal. "]
[text size=80 default="Speech includes repetitive sounds and conversational babble. "]
[text size=80 default="No concerns regarding hearing. "]
[text size=80 default="Motor skills include pulling to a stand, cruising furniture, and use of pincer grasp. Waves bye-bye. "]
[text size=80 default="No problems with urine or stool. "]
[text size=80 default="Some night awakening and stranger anxiety. "]
[text size=80 default="All other systems are negative."][/conditional][conditional field="Q1" condition="(Q1).is('12 month')"]
[text size=80 default="Has done well over the past few months. "]
[text size=80 default="Nutrition includes formula feeding with ---/nursing
along with baby and table foods. "]
[text size=80 default="Growth is normal. "]
[text size=80 default="Speech includes repetitive sounds and conversational babble. "]
[text size=80 default="No concerns regarding hearing. "]
[text size=80 default="Motor skills include pulling to a stand, cruising furniture, and use of pincer grasp. Waves bye-bye. "]
[text size=80 default="No problems with urine or stool. "]
[text size=80 default="Some night awakening and stranger anxiety. "]
[text size=80 default="All other systems are negative."][/conditional][conditional field="Q1" condition="(Q1).is('15 month')"]
[text size=80 default="Has done well over the past few months. "]
[text size=80 default="Nutrition includes table foods along with whole milk and occasional juice. "]
[text size=80 default="Growth is normal. "]
[text size=80 default="Speech includes a few words and conversational babble. "]
[text size=80 default="No concerns regarding hearing. "]
[text size=80 default="Motor skills include walking, running, using a spoon, scribbling."]
[text size=80 default="No problems with urine or stool. "]
[text size=80 default="Temperament is moderate, for which parents use simple choice. "]
[text size=80 default="No significant sleep issues. "]
[text size=80 default="All other systems are negative."][/conditional][conditional field="Q1" condition="(Q1).is('2 year')"]
[text size=80 default="Has been generally healthy over the past few months. "]
[text size=80 default="Nutrition includes milk and a variety of foods.  "]
[text size=80 default="Vitamins/Fluoride.  "]
[text size=80 default="Growth is normal. "]
[text size=80 default="Speech includes two to three word sentences that are more than half intelligible. "]
[text size=80 default="Follows instructions. "]
[text size=80 default="No concerns regarding hearing. "]
[text size=80 default="Motor skills include running, kicking a ball, climbing steps, attempts at dressing, use of a spoon and fork and social interactions. "]
[text size=80 default="Temperament is moderate. "]
[text size=80 default="Parents use simple choice and time-out with good effect. "]
[text size=80 default="There is some interest in toileting but little initiative. "]
[text size=80 default="No significant sleep issues. "]
[text size=80 default="No significant reaction to previous immunizations. "]
[text size=80 default="No lead risk/Not exposed to housing 1950 or older.  "]
[text size=80 default="No TB risk/exposure to TB is unlikely.  "]
[text size=80 default="Neither parent with cholesterol greater than 300.  "]
[text size=80 default="All other systems are negative."][/conditional][conditional field="Q1" condition="(Q1).is('3 year')"]
[text size=80 default="Has been generally healthy over the past few months. "]
[text size=80 default="Nutrition includes milk and a variety of foods.  "]
[text size=80 default="Vitamins/Fluoride  "]
[text size=80 default="Growth is normal. "]
[text size=80 default="Speech includes three to four word sentences that are more than 3/4 intelligible. "]
[text size=80 default="Motor skills include throwing a ball overhand, building a six-cube tower, washing and drying hands, dressing and undressing, walking up and down steps, cutting with scissors, and interest in toileting. "]
[text size=80 default="Parents use simple choice and time-out with good effect. "]
[text size=80 default="No significant sleep issues. "]
[text size=80 default="Social interactions are fine. "]
[text size=80 default="No significant reaction to previous immunizations. "]
[text size=80 default="No lead risk/Not exposed to housing 1950 or older.  No TB risk/exposure to TB is unlikely.  Neither parent with cholesterol greater than 300.  "]
[text size=80 default="All other systems are negative."][/conditional][conditional field="Q1" condition="(Q1).is('4 year')"]
[text size=80 default="Has been generally healthy over the past year. "]
[text size=80 default="Nutrition includes milk and a variety of foods. "]
[text size=80 default="Growth is normal. "]
[text size=80 default="Speech includes full sentences that are more than 3/4 intelligible. "]
[text size=80 default="Identifies colors and shapes. "]
[text size=80 default="Motor skills include dressing and undressing, toileting, hopping on one foot. "]
[text size=80 default="Social interactions are fine. Plays with other children. "]
[text size=80 default="Parents use simple choice and time-out with good effect. "]
[text size=80 default="All other systems are negative."][/conditional][conditional field="Q1" condition="(Q1).is('5 year')"]
[text size=80 default="Has been generally healthy over the past year. "]
[text size=80 default="Nutrition includes milk and a variety of foods. "]
[text size=80 default="Growth is normal. "]
[text size=80 default="Speech and motor skills are normal for age.  "]
[text size=80 default="Dresses without supervision, draws person, defines 5/8 ball, lake, desk, house, banana, curtain, fence, ceiling, and balances on each foot four seconds.  "]
[text size=80 default="No concerns regarding school readiness. "]
[text size=80 default="No problems with toileting. "]
[text size=80 default="Social interactions are fine. "]
[text size=80 default="Discussed anger style. Behavior approach includes time-out and simple choices.  "]
[text size=80 default="No previous reaction to immunizations.  "]
[text size=80 default="No lead exposure risk.  "]
[text size=80 default="All other systems are negative."][/conditional][conditional field="Q1" condition="(Q1).is('6-10 year')"]
[text size=80 default="Has been generally healthy over the past year. "]
[text size=80 default="Nutrition includes a variety of foods and good milk intake. "]
[text size=80 default="Growth is normal. "]
[text size=80 default="Exercise is regular. "]
[text size=80 default="No height/weight concerns. "]
[text size=80 default="No school performance or social interaction concerns. "]
[text size=80 default="Discussed anger style, moods. "]
[text size=80 default="Typical dependence issues with choice and time-out/privileges approach. "]
[text size=80 default="No problems with urine or stool. "]
[text size=80 default="Denies smoking. "]
[text size=80 default="All other systems are negative."][/conditional][conditional field="Q1" condition="(Q1).is('11-14 year')"]
[text size=80 default="Has been generally healthy over the past year. "]
[text size=80 default="Nutrition includes a variety of foods and good milk intake. "]
[text size=80 default="Growth is normal. "]
[text size=80 default="Exercise is regular. "]
[text size=80 default="No height/weight concerns. "]
[text size=80 default="No school performance or social interaction concerns. "]
[text size=80 default="Discussed anger style, moods, etc. Typical independence issues with choice and privileges approach. "]
[text size=80 default="No problems with urine or stool. "]
[text size=80 default="Denies sexual activity, smoking, alcohol or other drug use. "]
[text size=80 default="All other systems are negative."][/conditional][conditional field="Q1" condition="(Q1).is('15-18 year')"]
[text size=80 default="Has been generally healthy over the past year. "]
[text size=80 default="Nutrition includes a variety of foods and good milk intake. "]
[text size=80 default="Growth is normal. "]
[text size=80 default="Exercise is regular. "]
[text size=80 default="No height/weight concerns. "]
[text size=80 default="Education and work plans ***. "]
[text size=80 default="Denies depression/anhedonia. "]
[text size=80 default="No problems with urine or stool. "]
[text size=80 default="Denies sexual activity, smoking, alcohol or other drug use. "]
[text size=80 default="All other systems are negative."][/conditional]

Objective/Examination
[select name="Q2" value="newborn male|newborn female|less than 1 year old male|less than 1 year old female|1-4 year old male|1-4 year old female|greater than 4 year old male|greater than 4 year old female"][conditional field="Q2" condition="(Q2).is('newborn 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="Q2" condition="(Q2).is('newborn 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="Q2" condition="(Q2).is('less than 1 year old 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="Q2" condition="(Q2).is('less than 1 year old 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 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="Q2" condition="(Q2).is('1-4 year old 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="Q2" condition="(Q2).is('1-4 year old 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="Q2" condition="(Q2).is('greater than 4 year old 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="Q2" condition="(Q2).is('greater than 4 year old 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
[select name="Q3" value="1 week|2 month|4 month|6 month|9 month|12 month|15 month|2 year|3 year|4 year|5 year|6-10 year|11-14 year|15-18 year"][conditional field="Q3" condition="(Q3).is('1 week')"]
[textarea cols=144  default="#1 Normal growth and development.  Injury prevention and health promotion issues discussed.  Age specific guidance: infant should sleep on back, pets (keep separated from child), use of car restraints, do not leave near water or where child can fall, assure water heater temp. set less than 120 degrees and test fire alarms. "]
[textarea cols=144  default="No immunizations/Hepatitis B given today. Side effects, risks, and benefits of immunizations discussed."]
[textarea cols=144  default="Return to clinic at 2 months of age, or sooner if concerns arise.  Approved for all routine preventive medicine services, including immunizations.  Abuse/neglect, functional status, nutrition and pain assessed and no further evaluation is needed."][/conditional][conditional field="Q3" condition="(Q3).is('2 month')"]
[textarea cols=144  default="#1 Normal growth and development.  Age specific guidance: infant should sleep on back, use car restraints, do not leave the child near water or where the child can fall, do not use walkers or small toys and burn prevention reviewed."]
[textarea cols=144  default="Immunizations today: HBV-Hib, DTaP, and IPV (Hepatitis B-Haemophilus influenza, Diphtheria-Tetanus-acellular Pertussis and polio), PCV7 (Pneumococcal), Rota.  Side effects, risks, and benefits of immunizations discussed."]
[textarea cols=144  default="Return to clinic at 4 months of age, or sooner if concerns arise. Approved for all routine preventive medicine services, including immunizations. Abuse/neglect, functional status, nutrition and pain assessed and no further evaluation is needed."][/conditional][conditional field="Q3" condition="(Q3).is('4 month')"]
[textarea cols=144  default="#1 Normal growth and development.  Age specific guidance: use car restraints, do not leave near water or where the child can fall, do not use walkers or small toys, avoidance of plastic's suffocation and burn prevention reviewed. A/B Otic drops prescription and discussion about how to use as needed."]
[textarea cols=144  default="Immunizations today: Hib, DTaP, and IPV (Hepatitis B- Haemophilus influenza, Diphtheria-Tetanus, acellular Pertussis and polio), PCV7 (Pneumococcal), Rotavirus.  Side effects, risks, and benefits of immunizations discussed."]
[textarea cols=144  default="Return to clinic at 6 months of age, or sooner if concerns arise. Approved for all routine preventive medicine services, including immunizations. Abuse/neglect, functional status, nutrition and pain assessed and no further evaluation is needed."][/conditional][conditional field="Q3" condition="(Q3).is('6 month')"]
[textarea cols=144  default="#1 Health Maintenance-Normal Growth and Development.  Age specific guidance:  use of car restraints, supervise around water or where the child can fall, use gates to block stairway, be careful of cords and plants, do not use walkers or allow with small objects, burn prevention reviewed. "]
[textarea cols=144  default="Side effects, risks and benefits of immunizations.  Immunizations today:  DTaP (Diphtheria-Tetanus-acellular Pertussis)/HBV (hepatitis)/PCV7 (Pneumococcal)/ROTA (Rotavirus)"]
[textarea cols=144  default="Return appointment: age nine months/age twelve months/age fifteen months or sooner if needed."][/conditional][conditional field="Q3" condition="(Q3).is('9 month')"]
[textarea cols=144  default="#1 Normal growth and development.  Injury prevention and health promotion issues discussed."]
[textarea cols=144  default="No immunizations given today/Immunizations given today.  Side effects, risks, and benefits of immunizations discussed."]
[textarea cols=144  default="Return to clinic at 12 months of age, or sooner if concerns arise. Approved for all routine preventive medicine services, including immunizations.  Abuse/neglect, functional status, nutrition and pain assessed and no further evaluation is needed."][/conditional][conditional field="Q3" condition="(Q3).is('12 month')"]
[textarea cols=144  default="#1 Normal growth and development.  Injury prevention and health promotion issues discussed."]
[textarea cols=144  default="No immunizations given today/Immunizations given today.  Side effects, risks, and benefits of immunizations discussed."]
[textarea cols=144  default="Return to clinic at 15 months of age, or sooner if concerns arise. Approved for all routine preventive medicine services, including immunizations.  Abuse/neglect, functional status, nutrition and pain assessed and no further evaluation is needed."][/conditional][conditional field="Q3" condition="(Q3).is('15 month')"]
[textarea cols=144  default="#1 Health Maintenance-Normal Growth and Development.  Age specific guidance: choking, use of gates, caution around open water, falling, sunscreen if summer, smoke detectors, smoke free environment, lower crib mattress, check window guards, supervise near dogs and lawnmowers and streets and driveways, burn prevention, and tantrum information reviewed. Recommended to eat meals as family, allow toddler to feed self and drink from cup not bottle, 2 snacks low in sugar daily, avoid choke foods, don't put toddler to bed with bottle, brush teeth daily, fluoride discussed. Give individual attention, limit but enforce rules, allow no harm to self or things or others, delay toilet training."]
[textarea cols=144  default="Poison prevention discussed -- Keep potential poisons out of sight and out of reach. Always reengage child-resistant closures immediately after using a pharmaceutical or consumer product. Never transfer a substance from its original container to an alternate one. Safely dispose of all unused medication and medication that is no longer needed. Do not refer to medicines as candy. Post the poison control center number near the telephone. The universal telephone number in the United States is 800-222-1222. Calls are routed to the local poison control center.  Tuberculosis Risk (Close contact with person with TB, live in area where TB is common, recent immigrant?): No/Yes, testing recommended"]
[textarea cols=144  default="Side effects, risks and benefits of immunizations discussed.  Immunizations today: DTaP/Hib/PCV7/Influenza vaccine/HAV"]
[textarea cols=144  default="Return appointment: age two years/age 18 month visit with doctor/age 18 month visit with nurse for immunizations or sooner if needed."][/conditional][conditional field="Q3" condition="(Q3).is('2 year')"]
[textarea cols=144  default="#1 Normal growth and development.  Age specific guidance: Burn prevention, care near streets, caution around open water, use of car seats, transition from crib to bed, toilet training, night terrors and tantrum information reviewed."]
[textarea cols=144  default="No immunizations given today/Influenza/Hepatitis A/Side effects, risks, and benefits of immunizations discussed."]
[textarea cols=144  default="Return to clinic at 3 years of age, or sooner if concerns arise. Approved for all routine preventive medicine services, including immunizations.  Testing is/not indicated for TB (exposure to patient with TB, recent immigrant, area with high TB prevalence).  Testing is/not indicated for lead (house older than 1950).  Abuse/neglect, functional status, nutrition and pain assessed and no further evaluation is needed."][/conditional][conditional field="Q3" condition="(Q3).is('3 year')"]
[textarea cols=144  default="#1 Normal growth and development.  Age specific guidance: Burn prevention, care near streets, caution around open water, use of car seats, transition from crib to bed, use of bike helmet, toilet training, night terrors and tantrum information reviewed."]
[textarea cols=144  default="No immunizations given today/Immunizations given today/MMR (Measles-Mumps-Rubella)/Side effects, risks, and benefits of immunizations discussed."]
[textarea cols=144  default="Vision screening: assessed/not assessed/child uncooperative.  Hearing screening: assessed/not assessed/child uncooperative.  Testing is/not indicated for TB (exposure to patient with TB, recent immigrant, area with high TB prevalence).  Testing is/not indicated for lead (house older than 1950).  "]
[textarea cols=144  default="Return to clinic at 5 years of age, or sooner if concerns arise. Approved for all routine preventive medicine services, including immunizations. Abuse/neglect, functional status, nutrition and pain assessed and no further evaluation is needed."][/conditional][conditional field="Q3" condition="(Q3).is('4 year')"]
[textarea cols=144  default="#1 Normal growth and development.  Injury prevention and health promotion issues discussed."]
[textarea cols=144  default="No immunizations given today/Immunizations given today..  Side effects, risks, and benefits of immunizations discussed."]
[textarea cols=144  default="Return to clinic in two years or sooner if concerns arise.  Approved for all routine preventive medicine services, including immunizations. Abuse/neglect, functional status, nutrition and pain assessed and no further evaluation is needed."][/conditional][conditional field="Q3" condition="(Q3).is('5 year')"]
[textarea cols=144  default="#1 Health Maintenance-Normal Growth and Development.  Age specific guidance: Burn prevention (matches), care near streets, caution around open water, use of seatbelt information reviewed, self-esteem issues, limit television time, use of helmets when riding bike or scooter"]
[textarea cols=144  default="Immunizations today: None/DTaP/MMRV/IPV/Flu/Hep A.  Side effects, risks and benefits of immunizations."]
[textarea cols=144  default="Vision screening: assessed/not assessed/child uncooperative.  Hearing screening: assessed/not assessed/child uncooperative.  Return appointment: age 7 yrs/age 9 yrs or sooner if needed."][/conditional][conditional field="Q3" condition="(Q3).is('6-10 year')"]
[textarea cols=144  default="#1 Normal growth and development.  Injury prevention and health promotion issues discussed."]
[textarea cols=144  default="No immunizations given today/Immunizations given today.  Side effects, risks, and benefits of immunizations discussed."]
[textarea cols=144  default="Return to clinic in 2 years or sooner if concerns arise. Approved for all routine preventive medicine services, including immunizations. Abuse/neglect, functional status, nutrition and pain assessed and no further evaluation is needed."][/conditional][conditional field="Q3" condition="(Q3).is('11-14 year')"]
[textarea cols=144  default="#1 Normal growth and development.  Injury prevention and health promotion issues discussed."]
[textarea cols=144  default="Immunizations given/No immunizations given today.  Side effects, risks, and benefits of immunizations discussed."]
[textarea cols=144  default="Return to clinic in 2 years or sooner if concerns arise. Approved for all routine preventive medicine services, including immunizations. Abuse/neglect, functional status, nutrition and pain assessed and no further evaluation is needed."][/conditional][conditional field="Q3" condition="(Q3).is('15-18 year')"]
[textarea cols=144  default="#1 Normal growth and development.  Injury prevention and health promotion issues discussed."]
[textarea cols=144  default="Immunizations given.  Side effects, risks, and benefits of immunizations discussed/No immunizations given today."]
[textarea cols=144  default="Return to clinic in 2 years or sooner if concerns arise. Approved for all routine preventive medicine services, including immunizations. Abuse/neglect, functional status, nutrition and pain assessed and no further evaluation is needed."][/conditional]