IP+SEEK Wave 2 Baseline: Newborn to 1 Year Question Title * 1. Please select your practice. Olentangy Pediatrics Hyde Park Pediatrics Mercy Navarre Pediatrics UH Rainbow Babies and Children's Hospital-Child Development Center Medina Pediatrics Children's Choice Pediatrics Forest Park Internal Medicine-Pediatrics Mid-Ohio Pediatrics & Adolescents The HealthCare Connection Question Title * 2. Provider Name. Please seeking MOC IV credit and who saw the parents for the chart reviewed. Question Title * 3. For the chart reviewed and being entered, in which month did the well visit occur? November December Question Title * 4. Was there documentation of counseling provided, or was a referral made, for this child that has someone in the house who smokes tobacco? Counseling Provided Referral Made No Documentation of Either N/A - no one in the home smokes tobacco Question Title * 5. Was there documentation of counseling provided, or was a referral made, for this child’s caregiver who has had a problem with drugs or alcohol in the last year? Counseling Provided Referral Made No Documentation of Either N/A – caregiver did not have a problem with drugs or alcohol Question Title * 6. Was there documentation of counseling provided, or was a referral made, for this child’s caregiver who has needed to cut back on drinking or drug use during the last year? Counseling Provided Referral Made No Documentation of Either N/A - caregiver did not need to cut back on drinking of drug use Question Title * 7. Was there documentation of counseling provided, or was a referral made, for this child’s family that worried their food would run out before they got money or Food Stamps to buy more? Counseling Provided Referral Made No Documentation of Either N/A - Food Secure Family Question Title * 8. Was there documentation of counseling provided, or was a referral made, for the child’s family where food they bought just did not last and they did not have money to buy more? Counseling Provided Referral Made No Documentation of Either N/A – Food Secure Family Question Title * 9. Was there documentation of counseling provided to this child’s caregiver who sometimes finds they need to hit/spank/shake the child? Yes No Documentation Question Title * 10. Was there documentation of counseling provided to this child’s caregiver who sometimes finds they get so angry they need to yell/scream at their child? Yes No Documentation Question Title * 11. Was there documentation of counseling provided to this child’s caregiver who sometimes finds they have been afraid of their partner? Yes No Documentation Question Title * 12. Was there documentation of counseling provided to this child’s caregiver who often feels that their child is difficult to take care of? Yes No Documentation Question Title * 13. Was there documentation of counseling provided to this child’s caregiver who wishes that they had more help with their child? Yes No Documentation Question Title * 14. Was there documentation of counseling provided to this child’s caregiver who often feels under extreme stress? Yes No Documentation Question Title * 15. Was there documentation of screening for Maternal Depression? Yes No Question Title * 16. If a screening tool was used for Maternal Depression, which tool: PHQ2 PHQ9 Edinburgh Did not screen for maternal depression Other (please specify the maternal depression screening tool used): Question Title * 17. If the rescreening result was positive, was there documentation of: Counseling Provided Referral Made No Documentation of Either N/A - screen was negative N/A - did not screen for maternal depression Question Title * 18. Some types of furniture have the potential to tip over when a child pulls on it or attempts to climb it (dressers, TV’s). Was there documentation of counseling provided to this child’s caregiver that all such pieces of furniture in the home should be secured to the wall? Yes No Documentation Question Title * 19. Was there documentation of counseling provided to this child’s caregiver who considers leaving their child alone on a changing table, couch, bed, or similar surface? Yes No Documentation Question Title * 20. Was there documentation of counseling provided to this child’s caregiver about using safety gates to protect their child at the top and bottom of all stairways in their house? Yes No Documentation Question Title * 21. Was there documentation of counseling provided to this child’s caregiver that a child should ride in an infant or convertible seat when in a car? Yes No Documentation Question Title * 22. Was there documentation of counseling provided to this child’s caregiver on the proper seat and direction (back seat, facing backward) that a child should ride when in a car? Yes No Documentation Question Title * 23. Was there documentation of counseling provided to this child’s caregiver about having the car seat installed - or checked - by a healthcare (e.g., nurse, firefighter) or law enforcement professional? Yes No Documentation Question Title * 24. Was there documentation of counseling provided to this child’s caregiver about not sleeping with their child - in an adult bed or on a couch, and during naps or at night? Yes No Documentation Question Title * 25. Was there documentation of counseling provided to this child’s caregiver about having a space (e.g. crib/pack n play) for their child to sleep in - both during naps and at night? Yes No Documentation Question Title * 26. Was there documentation of counseling provided to this child’s caregiver about always placing their child to sleep on their back - both during naps and at night? Yes No Documentation Question Title * 27. Was there documentation of counseling provided to this child’s caregiver about not having the child sleep with objects (e.g. crib bumpers, pillows, blankets, stuffed animals, toys) in their crib? Yes No Documentation Question Title * 28. Was there documentation of providing the phone number for Poison Control? Yes No Documentation Question Title * 29. Was there documentation of counseling provided to this child’s caregiver about having all vitamins and medications in their home either in locked storage OR out of the reach of children? Yes No Documentation Question Title * 30. Was there documentation of counseling provided to this child’s caregiver about having guns in the home in locked storage AND unloaded? Yes No Documentation Question Title * 31. Was there documentation of counseling provided to this child’s caregiver about taking a course in child lifesaving techniques within the past 3 years? Yes No Documentation Question Title * 32. Was there documentation of counseling provided to this child’s caregiver about making sure small objects (such as toy parts, coins, watch batteries, & small pieces of food) are out of reach of the child? Yes No Documentation Question Title * 33. Was there documentation of counseling provided to this child’s caregiver about any situations in which they would consider leaving their child alone in a tub with or without an infant tub seat? Yes No Documentation Question Title * 34. Was there documentation of counseling provided to this child’s caregiver about having a smoke detector for their home? Yes No Documentation Question Title * 35. Was there documentation of counseling provided to this child’s caregiver about having the hot water heater in their house adjusted to less than 120 degrees? Yes No Documentation Question Title * 36. Was there documentation of counseling provided to this child’s caregiver about not holding their child while drinking hot liquids (e.g., while standing, sitting, or walking)? Yes No Documentation Question Title * 37. Was there documentation of counseling provided to this child’s caregiver about having a carbon monoxide detector in their home? Yes No Documentation Done