BF Preparation # Question Response Action Purpose Main Panel 4a. What have you heard about breastfeeding? Text box Contents of text box go to Rapport, Reports Listen, ask, and assess for: S portion of care plan. Interest in breastfeeding Mom Interested in Myths Breastfeeding (This checkbox Concerns is marked by the user if mom is Support systems interested in breastfeeding.) 4b. Previous experience: Radio buttons: Yes No 4c. If previously breastfed, how did it go? Length of time (weeks) Rapport, Risk 338, Affirm Text box, Z9, Numeric, Previous Exp field Praise for BF PC 338 - Pregnant woman currently breastfeeding Reason for stopping: assignment grid. List box: BF Change Reason 4d. What does your family, friends, or partner say about Text box Contents of text box go to Rapport breastfeeding? S portion of care plan. Tell me about the changes you have noticed or Text box (in screen design, Rapport 4e. concerns you have about your breasts. combined with text box above) Listen, ask, and access for Flat Inverted Pierced Surgeries Pain/discharge Size 4f. We have moms who have breastfed before and Interest in BF PC The response goes to the Eligible for BF PC can help you with breastfeeding. I will have one Radio buttons: S portion of the care plan. assignment call you. Yes No 4g. Are you exclusively breastfeeding an infant from Radio buttons: Food Package a previous pregnancy? Yes No Bottom Panel
BF Preparation # Question Response Action Purpose Main Panel 4a. What have you heard about breastfeeding? Listen, ask, and assess for: Interest in breastfeeding Myths Concerns Support systems Text box Mom Interested in Breastfeeding (This checkbox is marked by the user if mom is interested in breastfeeding.) Contents of text box go to S portion of care plan. Rapport, Reports 4b. Previous experience: Radio buttons: Yes No 4c. If previously breastfed, how did it go? Affirm Praise 338 - Pregnant woman currently breastfeeding Length of time (weeks) Text box, Z9, Numeric, Reason for stopping: List box: BF Change Reason Rapport, Risk 338, Previous Exp field for BF PC assignment grid. 4d. What does your family, friends, or partner say about breastfeeding? Text box Contents of text box go to S portion of care plan. Rapport 4e. Tell me about the changes you have noticed or concerns you have about your breasts. Listen, ask, and access for Flat Inverted Pierced Surgeries Pain/discharge Size Text box (in screen design, combined with text box above) Rapport 4f. We have moms who have breastfed before and can help you with breastfeeding. I will have one call you. Interest in BF PC Radio buttons: Yes No The response goes to the S portion of the care plan. Eligible for BF PC assignment 4g. Are you exclusively breastfeeding an infant from a previous pregnancy? Radio buttons: Yes No Food Package Bottom Panel