Mel’s Pediatric Template

[comment memo="Hey there! A few things to know on using this template: 
1. make sure you're choosing the right ages for developmental history, physical exam, and plan
2. for ROS, if you want to see the symptoms listed, just choose the '...' option. Anything that isn't checked will show up as NEGATIVE in the final result
3. you can edit the PEx/plan before you calculate or after, doesnt matter. Just make sure you do it since everything in this template is NORMAL."]
PATIENT INFO

Initials:[text name="initials" default=""]

History Provided by: 
[checkbox name="providedhx" value="mother|father|patient"]

SUBJECTIVE
Chief Complaint/Reason for Visit:
[checkbox name="CC" value="well-child|vaccines|sick visit"][conditional field="CC" condition="(CC).is('sick visit')"]: [text name="chiefcomplaint" default=""][/conditional]

HPI:
[textarea cols=40 rows=5 name="HPI" default=""]

RECENT HISTORY:
[checkbox name="recent" value="non-contributory|day care/school attendance|sick contact|consumption of food outside home|travel|ER/UC visit|hospitalization/surgery/procedure|diagnostic/laboratory studies|specialty consults|new/changed medications|ABX use:"][text size=40]

Past Medical History:
[checkbox name="pmh" value="reviewed|non-contributory|immunization UTD|missing shots|frequent infections|asthma|allergies|eczema|other:"][textarea cols=40 rows=1]

Current medications:
[textarea cols=40 rows=1]
[checkbox name="medications" value="none|Rx|OTC|no side effects|effective|partially effective|not effective|not taking as prescribed|did not try|side effects"]

Allergies:
[checkbox name="allergies" value="none|NKDA|environmental allergies (see below)|food allergies (see below)|allergies to medications (see below)"]
[textarea cols=40 rows=1]

Social History:
[textarea cols=40 rows=1]

Family History:
[textarea cols=40 rows=1]

Developmental 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')"]
[textarea cols=40 rows=5 default="Has done well since hospital discharge. "]
[textarea cols=40 rows=5 default="Nursing/formula every 1-3 hours.  "]
[textarea cols=40 rows=5 default="Growth is normal. "]
[textarea cols=40 rows=5 default="Alert to sights and sounds. "]
[textarea cols=40 rows=5 default="Quiets with comforting. "]
[textarea cols=40 rows=5 default="Sleeps on back. "]
[textarea cols=40 rows=5 default="Newborn screen pending/negative/***.  "][/conditional][conditional field="Q1" condition="(Q1).is('2 month')"]
[textarea cols=40 rows=5 default="Has done well over the past month. "]
[textarea cols=40 rows=5 default="Nutrition includes feeding/nursing every 2-3 hours/--- formula every 2-3 hours. "]
[textarea cols=40 rows=5 default="Growth is normal. "]
[textarea cols=40 rows=5 default="Alert to sights and sounds. Coos and smiles. Turns to sound. Holds object. Recognizes face. "]
[textarea cols=40 rows=5 default="No concerns regarding hearing. "]
[textarea cols=40 rows=5 default="Sleeps on back. "]
[textarea cols=40 rows=5 default="Usual sleep pattern. "]
[/conditional][conditional field="Q1" condition="(Q1).is('4 month')"]
[textarea cols=40 rows=5 default="Has done well over the past two months. "]
[textarea cols=40 rows=5 default="Nutrition includes nursing/--- formula.  "]
[textarea cols=40 rows=5 default="Growth is normal. "]
[textarea cols=40 rows=5 default="Speech includes squealing and cooing. "]
[textarea cols=40 rows=5 default="No concerns regarding hearing. Responsive. Smiling. Reaches for objects. Hands to midline/mouth. Head up prone. Pivots while on stomach. "]
[textarea cols=40 rows=5 default="Usual sleep pattern. "]
[/conditional][conditional field="Q1" condition="(Q1).is('6 month')"]
[textarea cols=40 rows=5 default="Has done well over the past two months. "]
[textarea cols=40 rows=5 default="Nutrition includes --- formula/nursing plus solids. "]
[textarea cols=40 rows=5 default="Growth is normal. "]
[textarea cols=40 rows=5 default="Speech includes squealing, cooing, and some repetitive sounds. "]
[textarea cols=40 rows=5 default="No concerns regarding hearing. "]
[textarea cols=40 rows=5 default="Motor skills include rolling, sitting, and transferring with both hands. Looks for object. Toes to mouth. "]
[textarea cols=40 rows=5 default="No significant sleep issues. "]
[textarea cols=40 rows=5 default="No previous immunization reactions.  "]
[/conditional][conditional field="Q1" condition="(Q1).is('9 month')"]
[textarea cols=40 rows=5 default="Has done well over the past few months. "]
[textarea cols=40 rows=5 default="Nutrition includes formula feeding with ---/nursing
along with baby and table foods. "]
[textarea cols=40 rows=5 default="Growth is normal. "]
[textarea cols=40 rows=5 default="Speech includes repetitive sounds and conversational babble. "]
[textarea cols=40 rows=5 default="No concerns regarding hearing. "]
[textarea cols=40 rows=5 default="Motor skills include pulling to a stand, cruising furniture, and use of pincer grasp. Waves bye-bye. "]
[textarea cols=40 rows=5 default="Some night awakening and stranger anxiety. "]
[/conditional][conditional field="Q1" condition="(Q1).is('12 month')"]
[textarea cols=40 rows=5 default="Has done well over the past few months. "]
[textarea cols=40 rows=5 default="Nutrition includes formula feeding with ---/nursing
along with baby and table foods. "]
[textarea cols=40 rows=5 default="Growth is normal. "]
[textarea cols=40 rows=5 default="Speech includes repetitive sounds and conversational babble. "]
[textarea cols=40 rows=5 default="No concerns regarding hearing. "]
[textarea cols=40 rows=5 default="Motor skills include pulling to a stand, cruising furniture, and use of pincer grasp. Waves bye-bye. "]
[textarea cols=40 rows=5 default="Some night awakening and stranger anxiety. "]
[/conditional][conditional field="Q1" condition="(Q1).is('15 month')"]
[textarea cols=40 rows=5 default="Has done well over the past few months. "]
[textarea cols=40 rows=5 default="Nutrition includes table foods along with whole milk and occasional juice. "]
[textarea cols=40 rows=5 default="Growth is normal. "]
[textarea cols=40 rows=5 default="Speech includes a few words and conversational babble. "]
[textarea cols=40 rows=5 default="No concerns regarding hearing. "]
[textarea cols=40 rows=5 default="Motor skills include walking, running, using a spoon, scribbling."]
[textarea cols=40 rows=5 default="Temperament is moderate, for which parents use simple choice. "]
[textarea cols=40 rows=5 default="No significant sleep issues. "]
[/conditional][conditional field="Q1" condition="(Q1).is('2 year')"]
[textarea cols=40 rows=5 default="Has been generally healthy over the past few months. "]
[textarea cols=40 rows=5 default="Nutrition includes milk and a variety of foods.  "]
[textarea cols=40 rows=5 default="Vitamins/Fluoride.  "]
[textarea cols=40 rows=5 default="Growth is normal. "]
[textarea cols=40 rows=5 default="Speech includes two to three word sentences that are more than half intelligible. "]
[textarea cols=40 rows=5 default="Follows instructions. "]
[textarea cols=40 rows=5 default="No concerns regarding hearing. "]
[textarea cols=40 rows=5 default="Motor skills include running, kicking a ball, climbing steps, attempts at dressing, use of a spoon and fork and social interactions. "]
[textarea cols=40 rows=5 default="Temperament is moderate. "]
[textarea cols=40 rows=5 default="Parents use simple choice and time-out with good effect. "]
[textarea cols=40 rows=5 default="There is some interest in toileting but little initiative. "]
[textarea cols=40 rows=5 default="No significant sleep issues. "]
[textarea cols=40 rows=5 default="No significant reaction to previous immunizations. "]
[textarea cols=40 rows=5 default="No lead risk/Not exposed to housing 1950 or older.  "]
[textarea cols=40 rows=5 default="No TB risk/exposure to TB is unlikely.  "]
[textarea cols=40 rows=5 default="Neither parent with cholesterol greater than 300.  "]
[/conditional][conditional field="Q1" condition="(Q1).is('3 year')"]
[textarea cols=40 rows=5 default="Has been generally healthy over the past few months. "]
[textarea cols=40 rows=5 default="Nutrition includes milk and a variety of foods.  "]
[textarea cols=40 rows=5 default="Vitamins/Fluoride  "]
[textarea cols=40 rows=5 default="Growth is normal. "]
[textarea cols=40 rows=5 default="Speech includes three to four word sentences that are more than 3/4 intelligible. "]
[textarea cols=40 rows=5 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. "]
[textarea cols=40 rows=5 default="Parents use simple choice and time-out with good effect. "]
[textarea cols=40 rows=5 default="No significant sleep issues. "]
[textarea cols=40 rows=5 default="Social interactions are fine. "]
[textarea cols=40 rows=5 default="No significant reaction to previous immunizations. "]
[textarea cols=40 rows=5 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.  "]
[/conditional][conditional field="Q1" condition="(Q1).is('4 year')"]
[textarea cols=40 rows=5 default="Has been generally healthy over the past year. "]
[textarea cols=40 rows=5 default="Nutrition includes milk and a variety of foods. "]
[textarea cols=40 rows=5 default="Growth is normal. "]
[textarea cols=40 rows=5 default="Speech includes full sentences that are more than 3/4 intelligible. "]
[textarea cols=40 rows=5 default="Identifies colors and shapes. "]
[textarea cols=40 rows=5 default="Motor skills include dressing and undressing, toileting, hopping on one foot. "]
[textarea cols=40 rows=5 default="Social interactions are fine. Plays with other children. "]
[textarea cols=40 rows=5 default="Parents use simple choice and time-out with good effect. "]
[/conditional][conditional field="Q1" condition="(Q1).is('5 year')"]
[textarea cols=40 rows=5 default="Has been generally healthy over the past year. "]
[textarea cols=40 rows=5 default="Nutrition includes milk and a variety of foods. "]
[textarea cols=40 rows=5 default="Growth is normal. "]
[textarea cols=40 rows=5 default="Speech and motor skills are normal for age.  "]
[textarea cols=40 rows=5 default="Dresses without supervision, draws person, defines 5/8 ball, lake, desk, house, banana, curtain, fence, ceiling, and balances on each foot four seconds.  "]
[textarea cols=40 rows=5 default="No concerns regarding school readiness. "]
[textarea cols=40 rows=5 default="No problems with toileting. "]
[textarea cols=40 rows=5 default="Social interactions are fine. "]
[textarea cols=40 rows=5 default="Discussed anger style. Behavior approach includes time-out and simple choices.  "]
[textarea cols=40 rows=5 default="No previous reaction to immunizations.  "]
[textarea cols=40 rows=5 default="No lead exposure risk.  "]
[/conditional][conditional field="Q1" condition="(Q1).is('6-10 year')"]
[textarea cols=40 rows=5 default="Has been generally healthy over the past year. "]
[textarea cols=40 rows=5 default="Nutrition includes a variety of foods and good milk intake. "]
[textarea cols=40 rows=5 default="Growth is normal. "]
[textarea cols=40 rows=5 default="Exercise is regular. "]
[textarea cols=40 rows=5 default="No height/weight concerns. "]
[textarea cols=40 rows=5 default="No school performance or social interaction concerns. "]
[textarea cols=40 rows=5 default="Discussed anger style, moods. "]
[textarea cols=40 rows=5 default="Typical dependence issues with choice and time-out/privileges approach. "]
[textarea cols=40 rows=5 default="Denies smoking. "]
[/conditional][conditional field="Q1" condition="(Q1).is('11-14 year')"]
[textarea cols=40 rows=5 default="Has been generally healthy over the past year. "]
[textarea cols=40 rows=5 default="Nutrition includes a variety of foods and good milk intake. "]
[textarea cols=40 rows=5 default="Growth is normal. "]
[textarea cols=40 rows=5 default="Exercise is regular. "]
[textarea cols=40 rows=5 default="No height/weight concerns. "]
[textarea cols=40 rows=5 default="No school performance or social interaction concerns. "]
[textarea cols=40 rows=5 default="Discussed anger style, moods, etc. Typical independence issues with choice and privileges approach. "]
[textarea cols=40 rows=5 default="Denies sexual activity, smoking, alcohol or other drug use. "]
[/conditional][conditional field="Q1" condition="(Q1).is('15-18+ year')"]
[textarea cols=40 rows=5 default="Has been generally healthy over the past year. "]
[textarea cols=40 rows=5 default="Nutrition includes a variety of foods and good milk intake. "]
[textarea cols=40 rows=5 default="Growth is normal. "]
[textarea cols=40 rows=5 default="Exercise is regular. "]
[textarea cols=40 rows=5 default="No height/weight concerns. "]
[textarea cols=40 rows=5 default="Education and work plans ***. "]
[textarea cols=40 rows=5 default="Denies depression/anhedonia. "]
[textarea cols=40 rows=5 default="Denies sexual activity, smoking, alcohol or other drug use. "]
[/conditional]

REVIEW OF SYSTEMS
CONSTITUTIONAL:[select name="constitutional" value="Negative|..."][conditional field="constitutional" condition="(constitutional).is('...')"]
[checklist name="const_symptoms" value="fever|changed behavior|tired|decreased appetite|fussy|thirsty"][/conditional]
HEAD/FACE: [select name="head" value="Negative|..."][conditional field="head" condition="(head).is('...')"]
[checklist name="head_symptoms" value="headache|head injury|scalp swelling|facial pain|facial swelling"][/conditional]
EYES: [select name="eyes" value="Negative|..."][conditional field="eyes" condition="(eyes).is('...')"]
[checklist name="eye_symptoms" value="discharge|watery|itching|lid swelling|periorbital swelling"][/conditional]
EARS: [select name="ears" value="Negative|..."][conditional field="ears" condition="(ears).is('...')"]
[checklist name="ear_symptoms" value="pain/pressure|discharge|wax"][/conditional]
NOSE: [select name="nose" value="Negative|..."][conditional field="nose" condition="(nose).is('...')"]
[checklist name="nose_symptoms" value="discharge|PND|congestion|snoring|bleeding"][/conditional]
MOUTH: [select name="mouth" value="Negative|..."][conditional field="mouth" condition="(mouth).is('...')"]
[checklist name="mouth_symptoms" value="sores|teething|infection|swelling"][/conditional]
THROAT: [select name="throat" value="Negative|..."][conditional field="throat" condition="(throat).is('...')"]
[checklist name="throat_symptoms" value="sore throat|odynophagia|hoarseness"][/conditional]
NECK: [select name="neck" value="Negative|..."][conditional field="neck" condition="(neck).is('...')"]
[checklist name="neck_symptoms" value="pain|swelling|stiffness|swollen glands"][/conditional]
Chest/Respiratory:[select name="chest" value="Negative|..."][conditional field="chest" condition="(chest).is('...')"]
[checklist name="chest_symptoms" value="cough|phlegm|wheezing|shortness of breath|pain w/ breathing"][/conditional]
GI:[select name="gi" value="Negative|..."][conditional field="gi" condition="(gi).is('...')"]
[checklist name="gi_symptoms" value="poor appetite|nausea|vomiting|gas|food allergies|abdominal pain|diarrhea|constipation|rectal pain/itching|rectal bleeding|laxative use"][/conditional]
GU: [select name="gu" value="Negative|..."][conditional field="gu" condition="(gu).is('...')"]
[checklist name="gu_symptoms" value="dysuria|frequency|urgency|urine odor|blood in urine|discharge|swelling|itching|skin lesions/rash|vaginal bleeding|penile bleeding"][/conditional]
MSK: [select name="msk" value="Negative|..."][conditional field="msk" condition="(msk).is('...')"]
[checklist name="msk_symptoms" value="myalgias|localized muscle/soft tissue pain/swelling|arthralgias|localized joint pain/swelling|limping"][/conditional]
NEURO: [select name="neuro" value="Negative|..."][conditional field="neuro" condition="(neuro).is('...')"]
[checklist name="neuro_symptoms" value="dizziness|blackouts|seizures"][/conditional]
PSYCH: [select name="psych" value="Negative|..."][conditional field="psych" condition="(psych).is('...')"]
[checklist name="psych_symptoms" value="anxious|sleep problems"][/conditional]
LYMPH/HEMA: [select name="lymph" value="Negative|..."][conditional field="lymph" condition="(lymph).is('...')"]
[checklist name="hem_symptoms" value="gland swelling|unusual bruising|blood disorder|anemia"][/conditional]
ALLERGIES/IMMUNE: [select name="allergies" value="Negative|..."][conditional field="allergies" condition="(allergies).is('...')"]
[checklist name="allergy_symptoms" value="atopy|environmental allergies|asthma|food allergies|autoimmune dz"][/conditional]
DERM: [select name="derm" value="Negative|..."][conditional field="derm" condition="(derm).is('...')"]
[checklist name="derm_sx" value="generalized rash|facial rash|acral rash|localized rash|dryness|hives|redness|swelling|bruising|single lesion|grouped lesions|wound|bite"][/conditional]


Objective
Physical Exam
Height: 
[text size=40 name="height" default=""]
Weight: 
[text size=40 name="weight" default=""]
Vitals:
[textarea cols=40 rows=5 name="vitals" default=""]

[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')"]
[textarea cols=40 rows=5 default="Skin: Normal turgor and without lesions."]
[textarea cols=40 rows=5 default="Eyes: Red reflex present bilaterally. Pupils equally round and reactive to light"]
[textarea cols=40 rows=5 default="Head: Normocephalic with age appropriate fontanelles."]
[textarea cols=40 rows=5 default="Peripheral Vessels: Normal pulses and perfusion."]
[textarea cols=40 rows=5 default="Heart: Regular rate and rhythm; normal S1 and S2; no murmurs, gallops, or rubs."]
[textarea cols=40 rows=5 default="Lungs: Unlabored respirations; symmetric chest expansion; clear breath sounds."]
[textarea cols=40 rows=5 default="Abdomen: Soft, without organomegaly. Bowel sounds normal. Nontender without rebound. No masses palpable. No distention."]
[textarea cols=40 rows=5 default="Genitalia: Normal male external genitalia. Testes descended bilaterally. No hernia present."]
[textarea cols=40 rows=5 default="Spine: Straight with no lesions."]
[textarea cols=40 rows=5 default="Joints: Hips with full range-of-motion; negative Barlow and Ortolani."]
[textarea cols=40 rows=5 default="Extremities: No clubbing, cyanosis, or edema. Normal upper and lower extremities."]
[textarea cols=40 rows=5 default="Mental Status: Alert and in no distress. Appropriate for age."]
[textarea cols=40 rows=5 default="Neuro: Normal reflexes; normal tone; no focal deficits appreciated. Appropriate for age."][/conditional][conditional field="Q2" condition="(Q2).is('newborn female')"]
[textarea cols=40 rows=5 default="Skin: Normal turgor and without lesions."]
[textarea cols=40 rows=5 default="Eyes: Red reflex present bilaterally. Pupils equally round and reactive to light"]
[textarea cols=40 rows=5 default="Head: Normocephalic with age appropriate fontanelles."]
[textarea cols=40 rows=5 default="Peripheral Vessels: Normal pulses and perfusion."]
[textarea cols=40 rows=5 default="Heart: Regular rate and rhythm; normal S1 and S2; no murmurs, gallops, or rubs."]
[textarea cols=40 rows=5 default="Lungs: Unlabored respirations; symmetric chest expansion; clear breath sounds."]
[textarea cols=40 rows=5 default="Abdomen: Soft, without organomegaly. Bowel sounds normal. Nontender without rebound. No masses palpable. No distention."]
[textarea cols=40 rows=5 default="Genitalia: Normal female external genitalia. No hernia present."]
[textarea cols=40 rows=5 default="Spine: Straight with no lesions."]
[textarea cols=40 rows=5 default="Joints: Hips with full range-of-motion; negative Barlow and Ortolani."]
[textarea cols=40 rows=5 default="Extremities: No clubbing, cyanosis, or edema. Normal upper and lower extremities."]
[textarea cols=40 rows=5 default="Mental Status: Alert and in no distress. Appropriate for age."]
[textarea cols=40 rows=5 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')"]
[textarea cols=40 rows=5 default="General: Child appears age appropriate. "]
[textarea cols=40 rows=5 default="Vitals noted and stable."]
[textarea cols=40 rows=5 default="Skin: Normal turgor and without lesions."]
[textarea cols=40 rows=5 default="Head:  Normocephalic with age appropriate fontanelles."]
[textarea cols=40 rows=5 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."]
[textarea cols=40 rows=5 default="ENT: TMs gray, sharp landmarks, mobile. Nose clear. Palate is complete. Dentition normal for age. Tonsils small and non-inflamed bilaterally."]
[textarea cols=40 rows=5 default="Lymph Nodes: No significant lymphadenopathy."]
[textarea cols=40 rows=5 default="Thyroid: No thyromegaly; trachea midline without masses."]
[textarea cols=40 rows=5 default="Breasts: Without lesions or drainage."]
[textarea cols=40 rows=5 default="Heart: Regular rate and rhythm; normal S1 and S2; no murmurs, gallops, or rubs."]
[textarea cols=40 rows=5 default="Lungs: Unlabored respirations; symmetric chest expansion; clear breath sounds; no wheezes, crackles, rales, rhonchi, or retractions."]
[textarea cols=40 rows=5 default="Abdomen: Soft, without organomegaly. Bowel sounds normal. Non-tender without rebound. No masses palpable. No distention."]
[textarea cols=40 rows=5 default="Genitalia: Normal male external genitalia; testes descended bilaterally; no hernia."]
[textarea cols=40 rows=5 default="Spine: Straight with no lesions."]
[textarea cols=40 rows=5 default="Joints: Full range of motion about all joints."]
[textarea cols=40 rows=5 default="Extremities:  Peripheral pulses are equal. There is no clubbing, cyanosis or edema of the extremities. Capillary refill is less than 2 seconds."]
[textarea cols=40 rows=5 default="Gait: Normal and appropriate gait for age."]
[textarea cols=40 rows=5 default="Mental Status: Alert and in no distress. Appropriate for age."]
[textarea cols=40 rows=5 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')"]
[textarea cols=40 rows=5 default="General: Child appears age appropriate. Vitals noted and stable."]
[textarea cols=40 rows=5 default="Skin: Normal turgor and without lesions."]
[textarea cols=40 rows=5 default="Head:  Normocephalic with age appropriate fontanelles."]
[textarea cols=40 rows=5 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."]
[textarea cols=40 rows=5 default="ENT: TMs gray, sharp landmarks, mobile. Nose clear. Palate is complete. Dentition normal for age. Tonsils small and non-inflamed bilaterally."]
[textarea cols=40 rows=5 default="Lymph Nodes: No significant lymphadenopathy."]
[textarea cols=40 rows=5 default="Thyroid: No thyromegaly; trachea midline without masses."]
[textarea cols=40 rows=5 default="Breasts: Without lesions or drainage."]
[textarea cols=40 rows=5 default="Heart: Regular rate and rhythm; normal S1 and S2; no murmurs, gallops, or rubs."]
[textarea cols=40 rows=5 default="Lungs: Unlabored respirations; symmetric chest expansion; clear breath sounds; no wheezes, crackles, rales, rhonchi, or retractions."]
[textarea cols=40 rows=5 default="Abdomen: Soft, without organomegaly. Bowel sounds normal. Non-tender without rebound. No masses palpable. No distention."]
[textarea cols=40 rows=5 default="Genitalia: Normal female external genitalia."]
[textarea cols=40 rows=5 default="Spine: Straight with no lesions."]
[textarea cols=40 rows=5 Joints: Full range of motion about all joints."]
[textarea cols=40 rows=5 default="Extremities:  Peripheral pulses are equal. There is no clubbing, cyanosis or edema of the extremities. Capillary refill is less than 2 seconds."]
[textarea cols=40 rows=5 default="Gait: Normal and appropriate gait for age."]
[textarea cols=40 rows=5 default="Mental Status: Alert and in no distress. Appropriate for age."]
[textarea cols=40 rows=5 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')"]
[textarea cols=40 rows=5 default="General: Child appears age appropriate. Vitals noted and stable."]
[textarea cols=40 rows=5 default="Skin: Normal turgor and without lesions."]
[textarea cols=40 rows=5 default="Head:  Normocephalic."]
[textarea cols=40 rows=5 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."]
[textarea cols=40 rows=5 default="ENT: TMs gray, sharp landmarks, mobile. Nose clear. Palate is complete. Dentition normal for age. Tonsils small and non-inflamed bilaterally."]
[textarea cols=40 rows=5 default="Lymph Nodes: No significant lymphadenopathy."]
[textarea cols=40 rows=5 default="Thyroid: No thyromegaly; trachea midline without masses."]
[textarea cols=40 rows=5 default="Breasts: Without lesions or drainage."]
[textarea cols=40 rows=5 default="Heart: Regular rate and rhythm; normal S1 and S2; no murmurs, gallops, or rubs. "]
[textarea cols=40 rows=5 default="Lungs: Unlabored respirations; symmetric chest expansion; clear breath sounds; no wheezes, crackles, rales, rhonchi, or retractions."]
[textarea cols=40 rows=5 default="Abdomen: Soft, without organomegaly. Bowel sounds normal. Non-tender without rebound. No masses palpable. No distention."]
[textarea cols=40 rows=5 default="Genitalia: Normal male external genitalia; testes descended bilaterally; no hernia."]
[textarea cols=40 rows=5 default="Spine: Straight with no lesions."]
[textarea cols=40 rows=5 default="Joints: Full range of motion about all joints."]
[textarea cols=40 rows=5 default="Extremities:  Peripheral pulses are equal. There is no clubbing, cyanosis or edema of the extremities. Capillary refill is less than 2 seconds."]
[textarea cols=40 rows=5 default="Gait: Normal and appropriate gait for age."]
[textarea cols=40 rows=5 default="Mental Status: Alert and in no distress. Appropriate for age."]
[textarea cols=40 rows=5 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')"]
[textarea cols=40 rows=5 default="General: Child appears age appropriate. Vitals noted and stable."]
[textarea cols=40 rows=5 default="Skin: Normal turgor and without lesions."]
[textarea cols=40 rows=5 default="Head:  Normocephalic."]
[textarea cols=40 rows=5 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."]
[textarea cols=40 rows=5 default="ENT: TMs gray, sharp landmarks, mobile. Nose clear. Palate is complete. Dentition normal for age. Tonsils small and non-inflamed bilaterally."]
[textarea cols=40 rows=5 default="Lymph Nodes: No significant lymphadenopathy."]
[textarea cols=40 rows=5 default="Thyroid: No thyromegaly; trachea midline without masses."]
[textarea cols=40 rows=5 default="Breasts: Without lesions or drainage."]
[textarea cols=40 rows=5 default="Heart: Regular rate and rhythm; normal S1 and S2; no murmurs, gallops, or rubs. "]
[textarea cols=40 rows=5 default="Lungs: Unlabored respirations; symmetric chest expansion; clear breath sounds; no wheezes, crackles, rales, rhonchi, or retractions."]
[textarea cols=40 rows=5 default="Abdomen: Soft, without organomegaly. Bowel sounds normal. Non-tender without rebound. No masses palpable. No distention."]
[textarea cols=40 rows=5 default="Genitalia: Normal female external genitalia."]
[textarea cols=40 rows=5 default="Spine: Straight with no lesions."]
[textarea cols=40 rows=5 default="Joints: Full range of motion about all joints."]
[textarea cols=40 rows=5 default="Extremities:  Peripheral pulses are equal. There is no clubbing, cyanosis or edema of the extremities. Capillary refill is less than 2 seconds."]
[textarea cols=40 rows=5 default="Gait: Normal and appropriate gait for age."]
[textarea cols=40 rows=5 default="Mental Status: Alert and in no distress. Appropriate for age."]
[textarea cols=40 rows=5 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')"]
[textarea cols=40 rows=5 default="General: Child appears age appropriate. Vitals noted and stable."]
[textarea cols=40 rows=5 default="Skin: Normal turgor and without lesions."]
[textarea cols=40 rows=5 default="Head:  Normocephalic."]
[textarea cols=40 rows=5 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."]
[textarea cols=40 rows=5 default="ENT: TMs gray, sharp landmarks, mobile. Nose clear. Palate is complete. Dentition normal for age. Tonsils small and non-inflamed bilaterally."]
[textarea cols=40 rows=5 default="Lymph Nodes: No significant lymphadenopathy."]
[textarea cols=40 rows=5 default="Thyroid: No thyromegaly; trachea midline without masses."]
[textarea cols=40 rows=5 default="Breasts: Without lesions or drainage."]
[textarea cols=40 rows=5 default="Heart: Regular rate and rhythm; normal S1 and S2; no murmurs, gallops, or rubs. "]
[textarea cols=40 rows=5 default="Lungs: Unlabored respirations; symmetric chest expansion; clear breath sounds; no wheezes, crackles, rales, rhonchi, or retractions."]
[textarea cols=40 rows=5 default="Abdomen: Soft, without organomegaly. Bowel sounds normal. Non-tender without rebound. No masses palpable. No distention."]
[textarea cols=40 rows=5 default="Genitalia: Normal male external genitalia; testes descended bilaterally; no hernia."]
[textarea cols=40 rows=5 default="Spine: Straight with no lesions."]
[textarea cols=40 rows=5 default="Joints: Full range of motion about all joints."]
[textarea cols=40 rows=5 default="Extremities: Peripheral pulses are equal. There is no clubbing, cyanosis or edema of the extremities. Capillary refill is less than 2 seconds."]
[textarea cols=40 rows=5 default="Gait: Normal and appropriate gait for age."]
[textarea cols=40 rows=5 default="Mental Status: Alert, oriented, in no distress. Appropriate for age."]
[textarea cols=40 rows=5 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')"]
[textarea cols=40 rows=5 default="General: Child appears age appropriate. Vitals noted and stable."]
[textarea cols=40 rows=5 default="Skin: Normal turgor and without lesions."]
[textarea cols=40 rows=5 default="Head:  Normocephalic."]
[textarea cols=40 rows=5 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."]
[textarea cols=40 rows=5 default="ENT: TMs gray, sharp landmarks, mobile. Nose clear. Palate is complete. Dentition normal for age. Tonsils small and non-inflamed bilaterally."]
[textarea cols=40 rows=5 default="Lymph Nodes: No significant lymphadenopathy."]
[textarea cols=40 rows=5 default="Thyroid: No thyromegaly; trachea midline without masses."]
[textarea cols=40 rows=5 default="Breasts: Without lesions or drainage."]
[textarea cols=40 rows=5 default="Heart: Regular rate and rhythm; normal S1 and S2; no murmurs, gallops, or rubs. "]
[textarea cols=40 rows=5 default="Lungs: Unlabored respirations; symmetric chest expansion; clear breath sounds; no wheezes, crackles, rales, rhonchi, or retractions."]
[textarea cols=40 rows=5 default="Abdomen: Soft, without organomegaly. Bowel sounds normal. Non-tender without rebound. No masses palpable. No distention."]
[textarea cols=40 rows=5 default="Genitalia: Normal female external genitalia."]
[textarea cols=40 rows=5 default="Spine: Straight with no lesions."]
[textarea cols=40 rows=5 default="Joints: Full range of motion about all joints."]
[textarea cols=40 rows=5 default="Extremities: Peripheral pulses are equal. There is no clubbing, cyanosis or edema of the extremities. Capillary refill less than 2 seconds."]
[textarea cols=40 rows=5 default="Gait: Normal and appropriate gait for age."]
[textarea cols=40 rows=5 default="Mental Status: Alert, oriented, in no distress. Appropriate for age."]
[textarea cols=40 rows=5 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=40 rows=5 name="plan" default="- "]
[textarea cols=40 rows=5 default="- 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=40 rows=5 default="- No immunizations/Hepatitis B given today. Side effects, risks, and benefits of immunizations discussed."]
[textarea cols=40 rows=5 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=40 rows=5 name="plan" default="- "]
[textarea cols=40 rows=5 default="- 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=40 rows=5 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=40 rows=5 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=40 rows=5 name="plan" default="- "]
[textarea cols=40 rows=5 default="- 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=40 rows=5 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=40 rows=5 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=40 rows=5 name="plan" default="- "]
[textarea cols=40 rows=5 default="- 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=40 rows=5 default="- Side effects, risks and benefits of immunizations.  Immunizations today:  DTaP (Diphtheria-Tetanus-acellular Pertussis)/HBV (hepatitis)/PCV7 (Pneumococcal)/ROTA (Rotavirus)"]
[textarea cols=40 rows=5 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=40 rows=5 name="plan" default="- "]
[textarea cols=40 rows=5 default="- Normal growth and development.  Injury prevention and health promotion issues discussed."]
[textarea cols=40 rows=5 default="- No immunizations given today/Immunizations given today.  Side effects, risks, and benefits of immunizations discussed."]
[textarea cols=40 rows=5 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=40 rows=5 name="plan" default="- "]
[textarea cols=40 rows=5 default="- Normal growth and development.  Injury prevention and health promotion issues discussed."]
[textarea cols=40 rows=5 default="- No immunizations given today/Immunizations given today.  Side effects, risks, and benefits of immunizations discussed."]
[textarea cols=40 rows=5 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=40 rows=5 name="plan" default="- "]
[textarea cols=40 rows=5 default="- 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=40 rows=5 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=40 rows=5 default="- Side effects, risks and benefits of immunizations discussed.  Immunizations today: DTaP/Hib/PCV7/Influenza vaccine/HAV"]
[textarea cols=40 rows=5 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=40 rows=5 name="plan" default="- "]
[textarea cols=40 rows=5 default="- 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=40 rows=5 default="- No immunizations given today/Influenza/Hepatitis A/Side effects, risks, and benefits of immunizations discussed."]
[textarea cols=40 rows=5 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=40 rows=5 name="plan" default="- "]
[textarea cols=40 rows=5 default="- 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=40 rows=5 default="- No immunizations given today/Immunizations given today/MMR (Measles-Mumps-Rubella)/Side effects, risks, and benefits of immunizations discussed."]
[textarea cols=40 rows=5 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=40 rows=5 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=40 rows=5 name="plan" default="- "]
[textarea cols=40 rows=5 default="- Normal growth and development.  Injury prevention and health promotion issues discussed."]
[textarea cols=40 rows=5 default="- No immunizations given today/Immunizations given today..  Side effects, risks, and benefits of immunizations discussed."]
[textarea cols=40 rows=5 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=40 rows=5 name="plan" default="- "]
[textarea cols=40 rows=5 default="- 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=40 rows=5 default="- Immunizations today: None/DTaP/MMRV/IPV/Flu/Hep A.  Side effects, risks and benefits of immunizations."]
[textarea cols=40 rows=5 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=40 rows=5 name="plan" default="- "]
[textarea cols=40 rows=5 default="- Normal growth and development.  Injury prevention and health promotion issues discussed."]
[textarea cols=40 rows=5 default="- No immunizations given today/Immunizations given today.  Side effects, risks, and benefits of immunizations discussed."]
[textarea cols=40 rows=5 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=40 rows=5 name="plan" default="- "]
[textarea cols=40 rows=5 default="- Normal growth and development.  Injury prevention and health promotion issues discussed."]
[textarea cols=40 rows=5 default="- Immunizations given/No immunizations given today.  Side effects, risks, and benefits of immunizations discussed."]
[textarea cols=40 rows=5 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=40 rows=5 name="plan" default="- "]
[textarea cols=40 rows=5 default="- Normal growth and development.  Injury prevention and health promotion issues discussed."]
[textarea cols=40 rows=5 default="- Immunizations given.  Side effects, risks, and benefits of immunizations discussed/No immunizations given today."]
[textarea cols=40 rows=5 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]