%AM, %375 %13 %2015 %00:%Feb

CHDP Required Elements

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Dental assessment performed: No problem suspected, no referral needed
Nutritional Assessment Performed: No problem suspected, no referral needed
Age appropriate anticipatory guidance was reviewed: No problem suspected
Age appropriate developmental assessment was performed: No problem suspected
Age appropriate vision and hearing assessed: No problem suspected
Age appropriate Hgb and Hct assessed: No intervention needed
Lead exposure evaluated: No problem suspected
Urinalysis: No problem suspected
TB risk assessed: No need for intervention
BMI Percentile: _
Smoking:
-  Second hand smoke exposure: Yes [_] No [_]
- The patient uses tobacco: Yes [_] No [_]
- The patient/parent was counseled about risks of tobacco use: Yes [_] No [_]
The patient is enrolled in WIC: : Yes [_] No [_]
- If yes, Ht. Wt. and Hgb and Hct checked
Vaccines: Vaccination status was evaluated.  Age appropriate vaccines were recommended as follows: _
Follow Up is recommended in _.
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  • All templates, "autotexts", procedure notes, and other documents on these pages are intended as examples only.  Your documentation in the medical record should always reflect precisely your specific interaction with an individual patient.  Merely copying and pasting a prewritten note into a patient's chart is unethical, unsafe, and possibly fradulent.