Visit Documentation Forms: First Week Visit (3 to 5 Days)

Please correct the errors described below.

Visit Documentation Form: First Week Visit (3 to 5 Days)

HISTORY

DEVELOPMENT

  • Makes brief eye contact
  • Reflexively moves arms and legs
  • Turns head to side when on stomach
  • Holds fingers closed
  • Grasps reflexively

SOCIAL AND FAMILY HISTORY

REVIEW OF SYSTEMS

Required Field = Focus area for this Bright Futures Visit

PHYSICAL EXAMINATION

Required Field = Focus area for this Bright Futures Visit

Genitourinary:

ASSESSMENT

ANTICIPATORY GUIDANCE (Discussed and/or handout given )

  • Living situation and food security
  • Environmental tobacco exposure
  • Family support
  • General feeding guidance
  • Breast/formula-feeding guidance
  • Car safety seats
  • Safe sleep
  • Heatstroke prevention
  • Burn prevention
  • Transition home and sibling adjustment
  • Early brain development; calming
  • When to call; CPR; illness prevention

PLAN

Universal Screening

Selective Screening (based on risk assessment) (See Previsit Questionnaire.):

Follow-up

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