|
Accompanied
• • •
|
Home visit
|
|
Time frame
|
Severity
• • •
|
|
HEENT (+)
• • •
|
Comments
|
|
HEENT (-)
• • •
|
Comments
|
|
General (+)
• • •
|
Comments
|
|
General (-)
• • •
|
Comments
|
|
Other (+)
• • •
|
Comments
|
|
Other (-)
• • •
|
Comments
|
|
Concern
• • •
|
Comments
|
|
Allergic rhinitis exam
|
Asthma/Bronchitis exam
|
|
Bronchiolitis exam
|
Croup exam
|
|
Hand, foot, mouth exam
|
Herpangina exam
|
|
Influenza exam
|
Normal exam
|
|
OE exam
|
OM exam
|
|
OME exam
|
Pink eye exam
|
|
Scarlet fever exam
|
Sinusitis exam
|
|
Sore throat exam
|
Strep exam
|
|
Thrush exam
|
URI exam
|
|
URI/OM exam
|
Viral syndrome exam
|
|
Office procedures
• • •
|
Comments
|
|
In-office treatment
• • •
|
Comments
|
|
Prescription
• • •
|
OTC med.
• • •
|
|
|
|
|
Diagnosis/course
|
Rest
|
|
Liquids
|
Hydrate
|
|
Tylenol/Motrin
|
Spread of illness
|
|
|
|
|
Sudafed/Mucinex
|
Nasal saline
|
|
Topical camphor rub
|
Children < 4y
|
|
Elevate head
|
Humidifier
|
|
Bulb suction
|
Netty pot
|
|
Nasal steroid
|
Decongesting comments
|
|
|
|
|
Sore throat liquids
|
Lozenges/sprays
|
|
Culture pending
|
|
|
|
|
|
Start asthma sick plan
|
Create sick plan
|
|
MDI teaching
|
Combination inhaler BID
|
|
Beta agonist BID
|
Inhaled/nebulized steroid
|
|
Beta agonist Q 4
|
Return to baseline
|
|
3 days without cough
|
|
|
|
|
|
Croup cough
|
Cold air/steam
|
|
Strider plan
|
Oral steroids
|
|
|
|
|
OE- ear plugs
|
Pain timeline
|
|
Prophylaxis
|
|
|
|
|
|
Pinkeye recommendations
|
No RX
|
|
Return to school
|
> 5-6 days
|
|
|
|
|
Sinus therapy
|
Decongestant
|
|
extend antibiotics
|
|
|
|
|
|
Thrush meds
|
Treatment failure
|
|
|
|
|
Strep precautions
|
Contagious
|
|
3 days
|
|
|
|
|
|
Follow up conditional
|
Follow up (+)
|
|
|
Follow up Purpose
• • •
|
