Newborn Blood Screen 3-5 days Critical Congenital Heart Defect Screen NB Screen documented Immunizations A A A A A A A A A A Assess/give G G G G G G G G G G Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Immunization Consent Y / N signed N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Tuberculin Skin Test PROCEDURES (TST) at-risk screening STI/HIV at-risk screen Cervical Dysplasia Screen @ yrs HgB & HCT-@ 12 mo & at-risk screens Dyslipidemia @ 10 & 20 yrs, & at-risk all at-risk LEAD- LABS children <72 mo of age @ 9-12 mo & 24 mo, then if at- risk, screen @ 25-72 mo Water Source Id’d OH -9 Fluoride Supp- 6ms-6yr, can provide up to 16 yr HEALTH Fluoride Varnish- erupt of 1st tooth OH-11 KID’S Smile ORAL form Tobacco Use Assess Tobacco Use or exposure displayed 2nd hand smoke ASK/ Advise/ Refer TOBACCO Age Bright Futures appropriate anticipatory guidance provided to family/ adolescent @ all ages GUIDANCE Elevated BLLs MNT Environmental Pediatrician Dental Visit: Refer- Referrals 12mos & 3 yrs; At-risk begin @ 6 mos Other- specify Comments
PROCEDURES Newborn Blood Screen 3-5 days Critical Congenital Heart Defect Screen NB Screen documented Immunizations Assess/give A G A G A G A G A G A G A G A G A G A G Immunization Consent signed Y / N N/A Y / N N/A Y / N N/A Y / N N/A Y / N N/A Y / N N/A Y / N N/A Y / N N/A Y / N N/A Y / N N/A Tuberculin Skin Test (TST) at-risk screening STI/HIV at-risk screen Cervical Dysplasia Screen @ yrs LABS HgB & HCT-@ 12 mo & at-risk screens Dyslipidemia @ 10 & 20 yrs, & at-risk LEAD- all at-risk children <72 mo of age @ 9-12 mo & 24 mo, then if at- risk, screen @ 25-72 mo ORAL HEALTH Water Source Id’d OH -9 Fluoride Supp- 6ms-6yr, can provide up to 16 yr Fluoride Varnish- erupt of 1st tooth OH-11 KID’S Smile form TOBACCO Tobacco Use Assess Tobacco Use or exposure displayed 2nd hand smoke ASK/ Advise/ Refer GUIDANCE Bright Futures Age appropriate anticipatory guidance provided to family/ adolescent @ all ages Referrals Elevated BLLs MNT Environmental Pediatrician Dental Visit: Refer- 12mos & 3 yrs; At-risk begin @ 6 mos Other- specify Comments