Newborn First Visit
Patient is a [text] day Old [select value= "Select|M|F"] that presents to clinic for a well child check. Parental concerns: [textarea default="Post Partum Depression:"]. Complications during pregnancy/delivery: [textarea default=] How many wet diapers: [text] Sleep/Naps: sleeps [text] hours at night and naps [text]. Patient sleeps [textarea default= "location"] Food: [textarea default= "Breast/Formula:Frequency of feeds: How much: Time spent eating: Vitamin D drops for breast fed infants, 400 IUs daily, Iron supplement for pre-me 1mg/kg"] Child care: [textarea default= "When are you going back to work, child care?"] Home: [textarea default= "Who lives at home: Siblings: Parents occupation:"] Safety: [checklist value= "Put to sleep on back|No blankets, pillows or toys in crib|Firm mattress|Rear facing car seat|Never left unattended on raised surfaces"] [textarea default="Meds: Allergies: PMH: PSH: FH:"] [comment memo="PE: **Red reflex"]
There are 14 form elements.