Pediatrics
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HISTORY: [textarea cols=80 rows=1][checkbox name="informant" value="provided by parent|provided by other|unobtainable d/t parental anxiety and/or lack of knowledge|interpretation provided by family member|interpretation provided by MA"]
SPECIAL NEEDS: [textarea cols=80 rows=1][checkbox name="special" value="none|specialty"]
SOCIAL HISTORY: [textarea cols=80 rows=1][checkbox name="risk" value="no changes|child care|housing|single parent|working parent|siblings"]

REVIEW OF SYSTEMS
Interval change: [textarea cols=80 rows=1][checkbox name="concerns" value="doing well, no changes since last visit|no illnesses or injuries|no specific concerns raised|no visits to health care providers, facilities|questionnaire provided & reviewed"]
Nutrition: [textarea cols=80 rows=1][checkbox name="nutrition" value="no concerns|milk less 16 oz"]
Toilet training: [textarea cols=80 rows=1][checkbox name="toilet" value="not yet|in progress|achieved"]
Behavior: [textarea cols=80 rows=1][checkbox name="behavior" value="no concerns"]
Play time 60 min/d: [textarea cols=80 rows=1][checkbox name="play" value="Yes|No"]
Screen time less 2 hours/d: [textarea cols=80 rows=1][checkbox name="screen" value="Yes|No"]

GROWTH: [textarea cols=80 rows=1][checkbox name="weight" value="chart provided, reviewed, developing well"]
MILESTONES: [textarea cols=80 rows=1][checkbox name="milestones" value="kicks ball, walks up/down stairs one step at a time, throws ball overhead, jumps up/down|turns book pages one at a time, stacks blocks|names pictures, 20 words, follows 2-step command|puts two words together|plays along other children, plays pretend games, imitates adults"]





=========================================



Appearance: [textarea cols=80 rows=1][checkbox name="appearance" value="well-appearing|active, interactive|no distress|uncooperative with exam"]
Skin: [textarea cols=80 rows=1][checkbox name="skin" value="pink, normal turgor|no rashes|no bruises"]
HEENT: [textarea cols=80 rows=1][checkbox name="ears" value="normocephalic, EOM intact, normal ocular alignment, normal canals & TMs, normal external nose, no dental decay, op w/o swelling or exudates"]
Neck: [textarea cols=80 rows=1][checkbox name="neck" value="supple, no LAD"]
Chest: [textarea cols=80 rows=1][checkbox name="chest" value="unlabored respirations, symmetric chest expansion, clear and equal breath sounds bilaterally"]
Heart: [textarea cols=80 rows=1][checkbox name="heart" value="regular rate & rhythm, no murmurs"]
Abdomen: [textarea cols=80 rows=1][checkbox name="abdomen" value="soft, nondistended, nontender, no obvious palpable masses"]
Genitalia: [textarea cols=80 rows=1][checkbox name="genitalia" value="normal appearance|uncircumcised| circumcised|testes down bilaterally"]
Musculoskeletal: [textarea cols=80 rows=1][checkbox name="extremities" value="no gross deformities, normal spine"]
Neuro: [textarea cols=80 rows=1][checkbox name="neuro" value="normal gait & coordination"]



===========================================




IMMUNIZATION: [textarea cols=80 rows=1][checkbox name="immunization" value="per schedule|deferred|declined"]

OUTSIDE ORDERS/REFERRALS: [textarea cols=80 rows=1][checkbox name="orders" value="none|laboratory studies|diagnostic studies|specialty|WIC"]

DISCUSSED AND/OR HANDOUT GIVEN/OFFERED: [textarea cols=80 rows=1][checkbox name="guide" value="playground safety, supervision outside|listen & respond to child, Interactive talking-singing-reading, limit TV, model appropriate language|appropriate choices, praise, help express feelings, self-quieting, help with fears & nightmares|toilet training when ready, use correct terms|healthy food choices, no forced foods, family meals"]

FOLLOW UP: [textarea cols=80 rows=1][checkbox name="follow" value="30 months of age, sooner if concerns arise"]
HISTORY:
SPECIAL NEEDS:
SOCIAL HISTORY:

REVIEW OF SYSTEMS
Interval change:
Nutrition:
Toilet training:
Behavior:
Play time 60 min/d:
Screen time less 2 hours/d:

GROWTH:
MILESTONES:





=========================================



Appearance:
Skin:
HEENT:
Neck:
Chest:
Heart:
Abdomen:
Genitalia:
Musculoskeletal:
Neuro:



===========================================




IMMUNIZATION:

OUTSIDE ORDERS/REFERRALS:

DISCUSSED AND/OR HANDOUT GIVEN/OFFERED:

FOLLOW UP:
Result - Copy and paste this output: