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Gestation - weeks
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Gestation - days
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Birth Weight - Pounds
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Birth Weight - Ounces
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Discharge Weight - Pounds
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Discharge Weight - Ounces
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Car Seat Challenge
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Gravida
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Para
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Delivery Method
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Assisted?
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Delivery complications
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Nuchal Cord
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APGAR 1 minute
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APGAR 5 minutes
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Meconium?
• • •
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Mother's age
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Mother's Blood Type
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Rubella Immune?
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VDRL negative?
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Hep B Surface Ag negative?
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GBS negative?
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GBS Treatment
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Infant Blood Type
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Direct Coombs
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PKU
• • •
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New Short Text Field
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Immunizations
• • •
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Bilirubin screening
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Bilirubin Value
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Hearing Screen
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Breastfeeding
• • •
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Breastfeeding Frequency
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Formula Type
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Formula Volume per Feed
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Urinating?
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Stooling
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Stool Description
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Development - Communicative
• • •
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Development - Physical
• • •
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Development - Cognitive
• • •
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Complete Note with Hospital Reco
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