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Baby and family has been doing well
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Parental Concerns or adjustment issues
• • •
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Parental Concerns/adjustment Comments
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Work/Child Care Plans
• • •
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Changes since last visit?
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Changes comments
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Nutrition
• • •
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Nutrition Comments
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Solid intakes
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Solids Comments
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Breastfeeding minutes per feed
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Breastfeeding Hours between feed
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Problems Breastfeeding
• • •
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Formula Type
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Ounces per Feeding
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Vitamins
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Elimination
• • •
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Sleep Normal
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Sleep Comments
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Passed Developmental and Behavioral Screen
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Reason for failing development exam
• • •
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Patient and baby was given guidance
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Anticip. Guidance - Nutrition
• • •
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Vaccines Discussed/VIS given
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Type of Vaccine
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