{"id":869,"date":"2024-12-26T14:58:28","date_gmt":"2024-12-26T14:58:28","guid":{"rendered":"https:\/\/protocols.pcc.com\/?p=869"},"modified":"2024-12-26T14:58:28","modified_gmt":"2024-12-26T14:58:28","slug":"limestone-pediatrics-snap-texts","status":"publish","type":"post","link":"https:\/\/protocols.pcc.com\/?p=869","title":{"rendered":"Limestone Pediatrics Snap Texts"},"content":{"rendered":"\n<p>Limestone Pediatrics is allowing us to share their practice Snap Texts with other clients. Limestone Pediatrics came from paper charts and wanted to make sure the change to charting in PCC EHR did not slow them down. They decided to utilize Snap Text with generic text boxes to replace many of the radio components.<br \/><\/p>\n\n\n\n<h2 class=\"wp-block-heading\">.newborn <\/h2>\n\n\n\n<p>Newborn Weight Check<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Discharge weight was ____________, current weight ________<\/li>\n\n\n\n<li>Feeding by<em> <\/em>____________, infant tolerating _________<\/li>\n\n\n\n<li>Stools have (not)started to transition<\/li>\n\n\n\n<li>Discharge bilirubin ____________ with light level of _________<em>. <\/em>Exam nota<em>ble for <\/em>________. T Bili?<\/li>\n\n\n\n<li>Follow up in <em>_____<\/em> days to confirm adequate weight gain and appropriate feeding<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">.2wkwcc <\/h2>\n\n\n\n<p>2 Week Well Child Check<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Returned to birth weight<\/li>\n\n\n\n<li>Feeding normally. Stools transitioned and normal. Numerous wet diapers per day<\/li>\n\n\n\n<li>Continue routine newborn care and establishing feeding plan<\/li>\n\n\n\n<li>Follow up at 1 month well child check<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">.1mwcc <\/h2>\n\n\n\n<p>1 Month Well Child Check<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Growing and developing normally<\/li>\n\n\n\n<li>Postpartum depression screening _________<\/li>\n\n\n\n<li>Continue routine neonatal care<\/li>\n\n\n\n<li>Follow up at 2 month wcc<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">.2mwcc <\/h2>\n\n\n\n<p>2 Month Well Child Check<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Growing and developing normally<\/li>\n\n\n\n<li>Postpartum Depression screening obtained and normal<\/li>\n\n\n\n<li>Administered 2 month vaccines today. PCV 20, Vaxelis (DtaP, IPV, Hep B, Hib) and Rotavirus<\/li>\n\n\n\n<li>Follow up at 4 month well child check<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">.4mwcc <\/h2>\n\n\n\n<p>4 Month Well Child Check<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Growing and developing normally<\/li>\n\n\n\n<li>Postpartum Depression screening obtained and normal<\/li>\n\n\n\n<li>Administered 4 month vaccines today. PCV 20, Vaxelis (DtaP, IPV, Hep B, Hib) and Rotavirus<\/li>\n\n\n\n<li>Follow up at 6 month well child check<\/li>\n<\/ul>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.6mwcc <\/h2>\n\n\n\n<p>6 Month Well Child Check<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Growing and developing normally<\/li>\n\n\n\n<li>Administered 6 month vaccines today. PCV 20, Vaxelis (DtaP, IPV, Hep B, Hib) and Rotavirus<\/li>\n\n\n\n<li>EDPS obtained today and negative<\/li>\n\n\n\n<li>Recommended influenza vaccine in the fall<\/li>\n\n\n\n<li>Follow up at 9 month well child check<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.9mwcc <\/h2>\n\n\n\n<p>9 Month Well Child Check<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Growing and developing normally<\/li>\n\n\n\n<li>Up to date on routine vaccinations<\/li>\n\n\n\n<li>Follow up at 12 month well child check<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.12mwcc <\/h2>\n\n\n\n<p>12 Month Well Child<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Growing and developing normally<\/li>\n\n\n\n<li>Vision screen normal<\/li>\n\n\n\n<li>Negative lead and TB screening questionnaires<\/li>\n\n\n\n<li>Hemoglobin obtained and normal for age<\/li>\n\n\n\n<li>Administer 12 month old vaccines (MMR, Varicella, PCV20)<\/li>\n\n\n\n<li>Follow up at 15 month well child check<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.15mwcc <\/h2>\n\n\n\n<p>15 Month Well Child Check<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Growing and developing normally<\/li>\n\n\n\n<li>Administer 15 month vaccines (Hep A and Hib)<\/li>\n\n\n\n<li>Follow up at 18 month well child check<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<h2 class=\"wp-block-heading\">.18mwcc <\/h2>\n\n\n\n<p>18 Month Well Child<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Growing and developing normally<\/li>\n\n\n\n<li>MCHAT obtained and normal for age<\/li>\n\n\n\n<li>Administer 18 month vaccines (DtaP)<\/li>\n\n\n\n<li>Follow up at 2 year old well child check<\/li>\n<\/ul>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.2yowcc <\/h2>\n\n\n\n<p>2 year old well check<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Growing and developing normally<\/li>\n\n\n\n<li>MCHAT obtained and normal today<\/li>\n\n\n\n<li>SPOT Vision normal today<\/li>\n\n\n\n<li>Lead screening questionnaire normal<\/li>\n\n\n\n<li>Administer 2 year old vaccines today (Hep A #2)<\/li>\n\n\n\n<li>Follow up at the 2.5 year old well check<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<h2 class=\"wp-block-heading\">.2.5yowcc <\/h2>\n\n\n\n<p>2.5 Year Old Well Check<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Growing and developing normally<\/li>\n\n\n\n<li>No major concerns from family today<\/li>\n\n\n\n<li>Up to date on all scheduled vaccines<\/li>\n\n\n\n<li>Follow up at 3 year old well child check<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">.3yowcc <\/h2>\n\n\n\n<p>3 Year Old Well Child Check<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Growing and developing normally<\/li>\n\n\n\n<li>No parental concerns today<\/li>\n\n\n\n<li>SPOT Vision normal today<\/li>\n\n\n\n<li>Up to date on all current vaccinations<\/li>\n\n\n\n<li>Follow up at 4 year old well child check<\/li>\n<\/ul>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.4yowcc <\/h2>\n\n\n\n<p>4 Year Old Well Child Check<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Growing and developing normally<\/li>\n\n\n\n<li>Vision screen normal<\/li>\n\n\n\n<li>No parental concerns today<\/li>\n\n\n\n<li>Administer 4 year old vaccines (Dtap, IPV, MMR and Varicella)<\/li>\n\n\n\n<li>Follow up in 12 months for next well child check<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<h2 class=\"wp-block-heading\">.kwcc <\/h2>\n\n\n\n<p>Kindergarten Well Child Check<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Growing and developing normally<\/li>\n\n\n\n<li>Physical exam form given today<\/li>\n\n\n\n<li>No major concerns from family<\/li>\n\n\n\n<li>UTD on vaccines<\/li>\n\n\n\n<li>Recommended Dental and Eye exams prior to starting Kindergarten<\/li>\n\n\n\n<li>Hearing screen passed<\/li>\n\n\n\n<li>Follow up in 1 year<\/li>\n<\/ul>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.5yowcc <\/h2>\n\n\n\n<p>Kindergarten Well Check<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Growing and developing normally<\/li>\n\n\n\n<li>Hearing screen passed and normal<\/li>\n\n\n\n<li>UTD on vaccines, recommended year influenza vaccine when appropriate<\/li>\n\n\n\n<li>Follow up in 1 year for next wcc<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.11yowcc<\/h2>\n\n\n\n<p>11 Year Old Well Child Check<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Growing and developing normally<\/li>\n\n\n\n<li>Parental and parent concerns discussed and addressed as above in history<\/li>\n\n\n\n<li>Administer MCV4 and TdaP today<\/li>\n\n\n\n<li>Discussed HPV vaccine and family plans to receive prior to age 15, will readdress at next annual visit<\/li>\n\n\n\n<li>Passed hearing and vision screens today<\/li>\n\n\n\n<li>Middle school physical form given<\/li>\n\n\n\n<li>Follow up in 1 year<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<h2 class=\"wp-block-heading\">.teenwcc <\/h2>\n\n\n\n<p>Annual Exam<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Growth following well, no concerns<\/li>\n\n\n\n<li>Parental and patient concerns addressed today<\/li>\n\n\n\n<li>PHQ9 and GAD7 obtained and _________<\/li>\n\n\n\n<li>Up to date on immunizations today, recommend influenza vaccine in the fall<\/li>\n\n\n\n<li>Follow up in 1 year<\/li>\n<\/ul>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.16yowcc <\/h2>\n\n\n\n<p>16 Year Old Well Check<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Growth and development on track<\/li>\n\n\n\n<li>Parental and patient concerns addressed today<\/li>\n\n\n\n<li>GAD7 and PHQ9 obtained and _________<\/li>\n\n\n\n<li>Administered MCV4 booster and MenB vaccines today<\/li>\n\n\n\n<li>Follow up in 1-2 months for MenB#2 as a NV<\/li>\n\n\n\n<li>Follow up in 1 year for next well check<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<h2 class=\"wp-block-heading\">.wcc <\/h2>\n\n\n\n<p>Annual Exam<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Growth and development on track<\/li>\n\n\n\n<li>Parental and patient concerns addressed today<\/li>\n\n\n\n<li>Up to date on current vaccines<\/li>\n\n\n\n<li>Follow up in 1 year<\/li>\n<\/ul>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.newbornfpe <\/h2>\n\n\n\n<p>General: Infant awake and alert<br \/>Eyes: Pupils equal round and reactive bilaterally, red reflex bilaterally, no scleral icterus<br \/>Head and Neck: Normocephalic, anterior fontanelle open soft and flat<br \/>ENT: Ear canals patent without erythema or discharge<br \/>CV: Heart regular rate and rhythm without murmurs, rubs or gallops<br \/>Respiratory: Lungs clear to auscultation bilaterally without wheeze or crackle<br \/>Skin: No abnormal rashes, lesions or bruises<br \/>GU: Normal external female genitalia without discharge<br \/>Abdomen: Soft, no masses palpated, no organomegaly. Umbilical stump intact without erythema or drainage<br \/>Hips: Negative Barlow and Ortolani<br \/>MSK: Moving all extremities normally, no step-offs on spine or dimples<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.newbornmpe <\/h2>\n\n\n\n<p>General: Infant awake and alert<br \/>Eyes: Pupils equal round and reactive bilaterally, red reflex bilaterally, no scleral icterus<br \/>Head and Neck: Normocephalic, anterior fontanelle open soft and flat<br \/>ENT: Ear canals patent without erythema or discharge<br \/>CV: Heart regular rate and rhythm without murmurs, rubs or gallops<br \/>Respiratory: Lungs clear to auscultation bilaterally without wheeze or crackle<br \/>Skin: No abnormal rashes, lesions or bruises<br \/>GU: Normal male penis with testicles palpable bilaterally<br \/>Abdomen: Soft, no masses palpated, no organomegaly. Umbilical stump intact without erythema or drainage<br \/>Hips: Negative Barlow and Ortolani<br \/>MSK: Moving all extremities normally, no step-offs on spine or dimples<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.infantfpe <\/h2>\n\n\n\n<p>General: Infant awake and alert<br \/>Eyes: Pupils equal round and reactive bilaterally, red reflex bilaterally, no scleral icterus<br \/>Head and Neck: Normocephalic, anterior fontanelle open soft and flat<br \/>ENT: Ear canals patent without erythema or discharge<br \/>CV: Heart regular rate and rhythm without murmurs, rubs or gallops<br \/>Respiratory: Lungs clear to auscultation bilaterally without wheeze or crackle<br \/>Skin: No abnormal rashes, lesions or bruises<br \/>GU: Normal external female genitalia without discharge<br \/>Abdomen: Soft, no masses palpated, no organomegaly. Umbilical stump intact without erythema or drainage<br \/>Hips: Negative Barlow and Ortolani<br \/>MSK: Moving all extremities normally, no step-offs on spine or dimples<br \/>Neurologic: Moro reflex intact, palmar and plantar reflexes present<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.infantmpe <\/h2>\n\n\n\n<p>General: Infant awake and alert<br \/>Eyes: Pupils equal round and reactive bilaterally, red reflex bilaterally, no scleral icterus<br \/>Head and Neck: Normocephalic, anterior fontanelle open soft and flat<br \/>ENT: Ear canals patent without erythema or discharge<br \/>CV: Heart regular rate and rhythm without murmurs, rubs or gallops<br \/>Respiratory: Lungs clear to auscultation bilaterally without wheeze or crackle<br \/>Skin: No abnormal rashes, lesions or bruises<br \/>GU: Normal male penis, testicles palpable bilaterally<br \/>Abdomen: Soft, no masses palpated, no organomegaly. Umbilical stump intact without erythema or drainage<br \/>Hips: Negative Barlow and Ortolani<br \/>MSK: Moving all extremities normally, no step-offs on spine or dimples<br \/>Neurologic: Moro reflex intact, palmar and plantar reflexes present<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.toddlerfpe <\/h2>\n\n\n\n<p>General: Patient awake and alert, in no acute distress<br \/>Eyes: Pupils equal round and reactive to light bilaterally, EOMI<br \/>ENT: Bilateral TM&#8217;s clear without erythema or bulge, nares parent without rhinorrhea, posterior oropharynx without erythema or exudate<br \/>CV: Heart regular rate and rhythm without murmurs, rubs or gallops<br \/>Respiratory: Lungs clear to auscultation bilaterally without wheeze or crackle<br \/>Skin: No abnormal rashes, lesions or bruises<br \/>GU: Normal external female genitalia without discharge<br \/>Abdomen: Soft, nontender, no masses palpated, no organomegaly<br \/>MSK: Moving all extremities normally<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.toddlermpe <\/h2>\n\n\n\n<p>General: Patient awake and alert, in no acute distress<br \/>Eyes: Pupils equal round and reactive to light bilaterally, EOMI<br \/>ENT: Bilateral TM&#8217;s clear without erythema or bulge, nares parent without rhinorrhea, posterior oropharynx without erythema or exudate<br \/>CV: Heart regular rate and rhythm without murmurs, rubs or gallops<br \/>Respiratory: Lungs clear to auscultation bilaterally without wheeze or crackle<br \/>Skin: No abnormal rashes, lesions or bruises<br \/>GU: Testicles palpable bilaterally, normal male penis without discharge<br \/>Abdomen: Soft, nontender, no masses palpated, no organomegaly<br \/>MSK: Moving all extremities normally<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.childfpe <\/h2>\n\n\n\n<p>General: Patient awake and alert, in no acute distress<br \/>Eyes: Pupils equal round and reactive to light bilaterally, EOMI<br \/>ENT: Bilateral TM&#8217;s clear without erythema or bulge, nares parent without rhinorrhea, posterior oropharynx without erythema or exudate<br \/>CV: Heart regular rate and rhythm without murmurs, rubs or gallops<br \/>Respiratory: Lungs clear to auscultation bilaterally without wheeze or crackle<br \/>Skin: No abnormal rashes, lesions or bruises<br \/>GU: Normal external female genitalia without discharge.<br \/>Abdomen: Soft, nontender, no masses palpated, no organomegaly<br \/>MSK: Moving all extremities normally, normal gait, no scoliosis noted<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.childmpe <\/h2>\n\n\n\n<p>General: Patient awake and alert, in no acute distress<br \/>Eyes: Pupils equal round and reactive to light bilaterally, EOMI<br \/>ENT: Bilateral TM&#8217;s clear without erythema or bulge, nares parent without rhinorrhea, posterior oropharynx without erythema or exudate<br \/>CV: Heart regular rate and rhythm without murmurs, rubs or gallops<br \/>Respiratory: Lungs clear to auscultation bilaterally without wheeze or crackle<br \/>Skin: No abnormal rashes, lesions or bruises<br \/>GU: Testicles palpable bilaterally, normal male penis without discharge<br \/>Abdomen: Soft, nontender, no masses palpated, no organomegaly<br \/>MSK: Moving all extremities normally, normal gait, no scoliosis noted<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.teenfpe <\/h2>\n\n\n\n<p>General: Patient awake and alert, in no acute distress<br \/>ENT: Bilateral TM&#8217;s clear without erythema or bulge, nares parent without rhinorrhea, posterior oropharynx without erythema or exudate<br \/>CV: Heart regular rate and rhythm without murmurs, rubs or gallops<br \/>Respiratory: Lungs clear to auscultation bilaterally without wheeze or crackle<br \/>Skin: No abnormal rashes, lesions or bruises<br \/>GU: Normal external female genitalia without discharge. Tanner stage  __________<br \/>Abdomen: Soft, nontender, no masses palpated, no organomegaly<br \/>MSK: Moving all extremities normally, normal gait, no scoliosis noted<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.teenmpe <\/h2>\n\n\n\n<p>General: Patient awake and alert, in no acute distress<br \/>ENT: Bilateral TM&#8217;s clear without erythema or bulge, nares parent without rhinorrhea, posterior oropharynx without erythema or exudate<br \/>CV: Heart regular rate and rhythm without murmurs, rubs or gallops<br \/>Respiratory: Lungs clear to auscultation bilaterally without wheeze or crackle<br \/>Skin: No abnormal rashes, lesions or bruises<br \/>GU: Testicles palpable bilaterally, no hernias palpated during Valsalva or cough, normal male penis without discharge, Tanner Stage ___________<br \/>Abdomen: Soft, nontender, no masses palpated, no organomegaly<br \/>MSK: Moving all extremities normally, normal gait, no scoliosis noted<\/p>\n<\/div><\/div>\n\n\n\n<h2 class=\"wp-block-heading\">.svpe <\/h2>\n\n\n\n<p>General: Patient awake and alert, in no acute distress<br \/>Eyes: Pupils equal, round and reactive to light bilaterally. No conjunctival injection or scleral irritation<br \/>ENT: Bilateral TM&#8217;s gray without erythema, bulge or retraction, nares patent without rhinorrhea, posterior oropharnyx without erythema or exudate<br \/>CV: Heart regular rate and rhythm without murmurs, rubs or gallops<br \/>Respiratory: Lungs clear to auscultation bilaterally without wheeze or crackle<br \/>Abdomen: Soft, nontender, no organomegaly<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">.adultmpe <\/h2>\n\n\n\n<p>General: Patient awake and alert, in no acute distress<br \/>ENT: Bilateral TM&#8217;s clear without erythema or bulge, nares parent without rhinorrhea, posterior oropharynx without erythema or exudate<br \/>CV: Heart regular rate and rhythm without murmurs, rubs or gallops<br \/>Respiratory: Lungs clear to auscultation bilaterally without wheeze or crackle<br \/>Skin: No abnormal rashes, lesions or bruises<br \/>GU: Denies any concerns including masses, painful areas, size differential between testicles or penile discharge. Exam deferred today<br \/>Abdomen: Soft, nontender, no masses palpated, no organomegaly<br \/>MSK: Moving all extremities normally, normal gait, no scoliosis noted<\/p>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.adhd <\/h2>\n\n\n\n<p>ADHD<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Doing well on current medication plan<\/li>\n\n\n\n<li>Discussed medical benefits of treatment and current side effects for patient<\/li>\n\n\n\n<li>KASPER reviewed and appropriate<\/li>\n\n\n\n<li>Continue currently prescribed medication as above<\/li>\n\n\n\n<li>Follow up in 4 months or sooner if concerns<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.adhdpe <\/h2>\n\n\n\n<p>General: Patient awake and alert, in no acute distress<br \/>Eyes: Pupils equal, round and reactive to light bilaterally. No conjunctival injection or scleral irritation<br \/>CV: Heart regular rate and rhythm without murmurs, rubs or gallops<br \/>Respiratory: Lungs clear to auscultation bilaterally without wheeze or crackle<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.adhdstart <\/h2>\n\n\n\n<p>ADHD<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Vanderbilt&#8217;s, patient history and family report all consistent with ADHD diagnosis<\/li>\n\n\n\n<li>Discussed treatment options and recommendations including a 504 plan or equivalent, therapy, and medication options<\/li>\n\n\n\n<li>Will plan to start medical treatment as above. Discussed risks and benefits of treatment<\/li>\n\n\n\n<li>Family to call in 7-10 days with update on medication performance<\/li>\n\n\n\n<li>Follow up in ___________<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.allergicconjunctivitis <\/h2>\n\n\n\n<p>Allergic Conjunctivitis<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Signs of symptoms of allergy related symptoms<\/li>\n\n\n\n<li>Very unlikely to be bacterial given the constellation of patient&#8217;s presentation<\/li>\n\n\n\n<li>Recommend Pat A Day allergic eye drops for the next 2-3 weeks<\/li>\n\n\n\n<li>Can add daily oral 2nd generation antihistamine such as Loratadine or Cetirizine as well<\/li>\n\n\n\n<li>Call if worsening or with further concerns<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.allergies <\/h2>\n\n\n\n<p>Allergic Rhinitis<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>History and exam consistent with allergies<\/li>\n\n\n\n<li>Recommended OTC allergy medication such as Zyrtec or claritin, following dosing recommendations for age<\/li>\n\n\n\n<li>If not improving or concerns can call clinic for further evaluation<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.attest<\/h2>\n\n\n\n<p> Attestation: I was present during the visit. I discussed the case with the Tristen Morrow, APRN and agree with the note as documented above for history, physical exam, diagnosis and plan.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.atypical <\/h2>\n\n\n\n<p>Atypical Pneumonia<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Patient presents with history and exam concerning for atypical pneumonia<\/li>\n\n\n\n<li>Start antibiotics as above<\/li>\n\n\n\n<li>Recommended good hydration and monitoring of symptoms.<\/li>\n\n\n\n<li>Cough may take several days to a few weeks to fully improve<\/li>\n\n\n\n<li>Call with changes or concerns<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.bedwetting <\/h2>\n\n\n\n<p>Nocturnal Enuresis<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Discussed that this is still very normal at this age<\/li>\n\n\n\n<li>Only data driven aids are bed wetting alarms<\/li>\n\n\n\n<li>Discussed the use of these<\/li>\n\n\n\n<li>Parents to call with concerns<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.bronchiolitis <\/h2>\n\n\n\n<p>Bronchiolitis<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Patient presents with history and exam consistent with bronchiolitis<\/li>\n\n\n\n<li>Discussed the various different viral etiologies and testing was _________<\/li>\n\n\n\n<li>Recommended saline and suction to control secretions<\/li>\n\n\n\n<li>Encouraged good hydration with fluids with a goal of at least 3 good wet diapers in a 24 hour period<\/li>\n\n\n\n<li>Discussed increased work of breathing and concerning features that would lead to recommendation to go do the ED<\/li>\n\n\n\n<li>May use tylenol and ibuprofen as needed<\/li>\n\n\n\n<li>Call with concerns.<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.chap <\/h2>\n\n\n\n<p>Sensitive exam portions were chaperoned by _______________<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.conjunctivitis<\/h2>\n\n\n\n<p>________ Conjunctivitis<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Start antibiotic drops as above<\/li>\n\n\n\n<li>Symptoms should be improving and on antibiotic drops for at least 24-48 hours before returning to school or daycare<\/li>\n\n\n\n<li>Call with any changes or concerns.<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.constipation <\/h2>\n\n\n\n<p>Constipation<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Exam and history consistent with constipation<\/li>\n\n\n\n<li>Given the short\/prolonged time period for symptoms would\/would not recommend full clean out<\/li>\n\n\n\n<li>Recommended starting 1 capful miralax once daily and titrate to soft, ice cream consistency, stools<\/li>\n\n\n\n<li>Continue this for the next 6-8 weeks for full resolution of symptoms.<\/li>\n\n\n\n<li>Also should increase water intake to at least 60 ounces of water per day<\/li>\n\n\n\n<li>If not improving over the next 7-10 days, call for further evaluation<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.croup <\/h2>\n\n\n\n<p>Croup<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Signs and symptoms consistent with croup<\/li>\n\n\n\n<li>History concerning for stridor and possible changes in work of breathing<\/li>\n\n\n\n<li>Start steroids as above<\/li>\n\n\n\n<li>Counseled that cool air and moist air both can aid greatly for stridor<\/li>\n\n\n\n<li>Strict return precautions given regarding work of breathing or breathing changes<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.flu <\/h2>\n\n\n\n<p>Influenza _____<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Patient presents with concerning signs for influenza<\/li>\n\n\n\n<li>Rapid Flu positive<\/li>\n\n\n\n<li>Discussed medical treatment options including prescribing Tamiflu. Risks and benefits of treatment were discussed including potential for nausea and vomiting.<\/li>\n\n\n\n<li>Start Tamiflu today as above<\/li>\n\n\n\n<li>Parents declined treatment today<\/li>\n\n\n\n<li>Encouraged good hydration, treat with Tylenol and ibuprofen, and to watch for increased work of breathing.<\/li>\n\n\n\n<li>Call with questions or concerns<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.gastro <\/h2>\n\n\n\n<p>Gastroenteritis<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Patient presents with history and exam concerning for viral gastroenteritis<\/li>\n\n\n\n<li>Recommended BRAT diet and encouraged fluids<\/li>\n\n\n\n<li>May take several days to resolve and if significant diarrhea to not consume any dairy until resolved for 48 hours<\/li>\n\n\n\n<li>Call with questions or concerns<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.granuloma <\/h2>\n\n\n\n<p>Umbilical Granuloma<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>No signs of infection at this time<\/li>\n\n\n\n<li>Discussed treatment options with family and cauterization was mutually decided as best treatment<\/li>\n\n\n\n<li>Risks and benefits of the procedure were discussed with parent. Silver nitrate was applied to the umbilicus until resolution of drainage was noted. Infant tolerated the procedure very well. There were no complications. Recommended no submerged bath for 48 hours.<\/li>\n\n\n\n<li>Family will call with questions or concerns<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.hfm <\/h2>\n\n\n\n<p>Hand, Foot and Mouth<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Symptoms and exam consistent with hand, food and mouth<\/li>\n\n\n\n<li>Hydration status is <strong><em><strong><em>_________<\/em><\/strong><\/em><\/strong><\/li>\n\n\n\n<li>Lesions will resolve over the course of 1-2 weeks, sometimes with peeling. Recommending hydrating skin<\/li>\n\n\n\n<li>Can return to activities once afebrile for 24 hours and any blistered lesions are resolving<\/li>\n\n\n\n<li>Call with questions or concerns.<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.infanturi <\/h2>\n\n\n\n<p>Viral Upper Respiratory Infection<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Symptoms consistent with viral upper respiratory infection<\/li>\n\n\n\n<li>No significant work of breathing or retractions noted<\/li>\n\n\n\n<li>Recommended good amounts of saline and limit suction to 3-4 times per day<\/li>\n\n\n\n<li>Encouraged good supportive care with appropriate hydration and analgesics as needed (tylenol)<\/li>\n\n\n\n<li>Return precautions given, call with concerns<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.lom <\/h2>\n\n\n\n<p>Left Otitis Media with _____________<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Exam and history concerning for otitis media with\/without systemic symptoms<\/li>\n\n\n\n<li>Start antibiotics per dosage above<\/li>\n\n\n\n<li>Continue supportive care with good hydration and pain control as needed<\/li>\n\n\n\n<li>Return precautions given (At least 3 urinations per 24 hours, improvement of symptoms of 3-4 days, etc)<\/li>\n\n\n\n<li>Family to call with any questions or concerns<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.lymph <\/h2>\n\n\n\n<p>Lymph: Shotty submandibular and anterior cervical lymphadenopathy bilaterally, largest node 3-4 mm in diameter<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.otitisexterna <\/h2>\n\n\n\n<p>Otitis Externa<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Exam and history consistent with otitis externa<\/li>\n\n\n\n<li>Start external ear drops as above<\/li>\n\n\n\n<li>Counseled to wear ear plugs while swimming during treatment<\/li>\n\n\n\n<li>Call if not improving or with concerns<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.return<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Return precautions given, call with changes or concerns<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.rom <\/h2>\n\n\n\n<p>Right Otitis Media with <strong><em><strong><em>_____________<\/em><\/strong><\/em><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Exam and history concerning for otitis media with\/without systemic symptoms<\/li>\n\n\n\n<li>Start antibiotics per dosage above<\/li>\n\n\n\n<li>Continue supportive care with good hydration and pain control as needed<\/li>\n\n\n\n<li>Return precautions given (At least 3 urinations per 24 hours, improvement of symptoms of 3-4 days, etc)<\/li>\n\n\n\n<li>Family to call with any questions or concerns<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.sinusitis <\/h2>\n\n\n\n<p>Bacterial Sinusitis with _____________<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Patient symptoms consistent with sinusitis, signs of systemic illness given __________<\/li>\n\n\n\n<li>Start antibiotic as prescribed above<\/li>\n\n\n\n<li>Counseled symptoms may take several days to abate, and should continue symptomatic treatment as needed<\/li>\n\n\n\n<li>May return back to school as tolerated<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.sports <\/h2>\n\n\n\n<p>Sports Physical<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Normal vision and vitals<\/li>\n\n\n\n<li>Normal physical exam without concerning findings<\/li>\n\n\n\n<li>History obtained via KHSAA sports physical documentation and attached<\/li>\n\n\n\n<li>Cleared for all athletic activity at this time<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.strep <\/h2>\n\n\n\n<p>Strep Pharyngitis<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Rapid strep test positive<\/li>\n\n\n\n<li>Start antibiotics as prescribed above<\/li>\n\n\n\n<li>Recommended supportive care (hydration, antipyretics and analgesics as needed)<\/li>\n\n\n\n<li>While data may be limited recommended changing toothbrush prior to completing antibiotics as well as wash all bedding, stuff animals, etc that are frequently in use as part of routine cleanliness following illness.<\/li>\n\n\n\n<li>Return precautions given, family to call with concerns<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.thrush <\/h2>\n\n\n\n<p>Oral Thrush<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Exam and history concerning for thrush<\/li>\n\n\n\n<li>Start nystatin as prescribed above<\/li>\n\n\n\n<li>Sterilize all bottles, pump equipment, pacifiers, etc nightly<\/li>\n\n\n\n<li>Call if not improving or with any other concerns<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.uri <\/h2>\n\n\n\n<p>Viral Upper Respiratory Infection<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Symptoms consistent with viral upper respiratory infection<\/li>\n\n\n\n<li>Recommended over the counter treatments as appropriate for age<\/li>\n\n\n\n<li>Encouraged good supportive care with appropriate hydration and analgesics as needed<\/li>\n\n\n\n<li>Return precautions given (Improvement in symptoms over next 4-5 days, down-trending of fever by day 5, etc)<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">.viralpharyngitis <\/h2>\n\n\n\n<p>Viral Pharyngitis<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Rapid Strep Negative, culture pending<\/li>\n\n\n\n<li>Will follow up on culture at 24 and 48 hours, contacting family if positive and will start appropriate antibiotics<\/li>\n\n\n\n<li>Likely viral etiology with current findings<\/li>\n\n\n\n<li>Recommended good supportive care, antipyretics as need, including Tylenol and ibuprofen<\/li>\n\n\n\n<li>Continue good hydration and diet as tolerated<\/li>\n\n\n\n<li>Return back to school once afebrile for 24 hours and symptoms resolving<\/li>\n<\/ul>\n<\/div><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Limestone Pediatrics is allowing us to share their practice Snap Texts with other clients. Limestone Pediatrics came from paper charts and wanted to make sure the change to charting in PCC EHR did not slow them down. They decided to utilize Snap Text with generic text boxes to replace many of the radio components. .newborn &hellip; <a href=\"https:\/\/protocols.pcc.com\/?p=869\" class=\"more-link\">Continue reading <span class=\"screen-reader-text\">Limestone Pediatrics Snap Texts<\/span> <span class=\"meta-nav\">&rarr;<\/span><\/a><\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[47],"tags":[],"class_list":["post-869","post","type-post","status-publish","format-standard","hentry","category-snap-text"],"_links":{"self":[{"href":"https:\/\/protocols.pcc.com\/index.php?rest_route=\/wp\/v2\/posts\/869","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/protocols.pcc.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/protocols.pcc.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/protocols.pcc.com\/index.php?rest_route=\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/protocols.pcc.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=869"}],"version-history":[{"count":7,"href":"https:\/\/protocols.pcc.com\/index.php?rest_route=\/wp\/v2\/posts\/869\/revisions"}],"predecessor-version":[{"id":887,"href":"https:\/\/protocols.pcc.com\/index.php?rest_route=\/wp\/v2\/posts\/869\/revisions\/887"}],"wp:attachment":[{"href":"https:\/\/protocols.pcc.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=869"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/protocols.pcc.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=869"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/protocols.pcc.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=869"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}