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WAVE 3 - Injury Plus SEEK Baseline Data Review
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1.
Please choose the practice for this data review.
(Required.)
The Pediatric Group at Upper Valley Medical Center - Troy
The Pediatric Group at Hyatt Center - Tipp City
The Pediatric Group at Outpatient Care Center North - Piqua
WinMed Health Services City West
WinMed Health Services Winneste Health Center
WinMed Health Services Community Action Agency
Marietta Memorial Hospital
University Hospitals Westshore Primary Care
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2.
Provider name for this chart:
(Required.)
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3.
For the chart reviewed and being entered, in which month did the well visit occur?
(Required.)
December 2020
January 2021
Other
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4.
What was the age of the child at this visit?
(Required.)
Birth - 12 months of age
18 months - 5 years of age
Other
5.
What documentation (if any) is present for the following topics:
Screening documented
Discussion (general)
Discussion (for positive screening)
Resources provided (such as a handout)
Referral provided (to a service provider)
No documentation of this topic
Tobacco Use
Screening documented
Discussion (general)
Discussion (for positive screening)
Resources provided (such as a handout)
Referral provided (to a service provider)
No documentation of this topic
Drug or Alcohol Use
Screening documented
Discussion (general)
Discussion (for positive screening)
Resources provided (such as a handout)
Referral provided (to a service provider)
No documentation of this topic
Food Insecurity
Screening documented
Discussion (general)
Discussion (for positive screening)
Resources provided (such as a handout)
Referral provided (to a service provider)
No documentation of this topic
Social Needs (Housing, employment, etc.)
Screening documented
Discussion (general)
Discussion (for positive screening)
Resources provided (such as a handout)
Referral provided (to a service provider)
No documentation of this topic
Domestic Violence
Screening documented
Discussion (general)
Discussion (for positive screening)
Resources provided (such as a handout)
Referral provided (to a service provider)
No documentation of this topic
Maternal Depression
Screening documented
Discussion (general)
Discussion (for positive screening)
Resources provided (such as a handout)
Referral provided (to a service provider)
No documentation of this topic
Stress/Parenting Difficulties
Screening documented
Discussion (general)
Discussion (for positive screening)
Resources provided (such as a handout)
Referral provided (to a service provider)
No documentation of this topic
6.
What documentation (if any) is present for the following topics:
Screening documented
Discussion (general)
Discussion (for positive screening)
Resources provided (such as a handout)
Referral provided (to a service provider)
No documentation of this topic
Furniture tip overs
Screening documented
Discussion (general)
Discussion (for positive screening)
Resources provided (such as a handout)
Referral provided (to a service provider)
No documentation of this topic
Stair and/or window safety
Screening documented
Discussion (general)
Discussion (for positive screening)
Resources provided (such as a handout)
Referral provided (to a service provider)
No documentation of this topic
Choking risks
Screening documented
Discussion (general)
Discussion (for positive screening)
Resources provided (such as a handout)
Referral provided (to a service provider)
No documentation of this topic
Car seat safety
Screening documented
Discussion (general)
Discussion (for positive screening)
Resources provided (such as a handout)
Referral provided (to a service provider)
No documentation of this topic
Water safety
Screening documented
Discussion (general)
Discussion (for positive screening)
Resources provided (such as a handout)
Referral provided (to a service provider)
No documentation of this topic
Smoke and/or CO detectors
Screening documented
Discussion (general)
Discussion (for positive screening)
Resources provided (such as a handout)
Referral provided (to a service provider)
No documentation of this topic
Poison prevention
Screening documented
Discussion (general)
Discussion (for positive screening)
Resources provided (such as a handout)
Referral provided (to a service provider)
No documentation of this topic
Firearms safety
Screening documented
Discussion (general)
Discussion (for positive screening)
Resources provided (such as a handout)
Referral provided (to a service provider)
No documentation of this topic
Life saving techniques (CPR, first-aid, etc.)
Screening documented
Discussion (general)
Discussion (for positive screening)
Resources provided (such as a handout)
Referral provided (to a service provider)
No documentation of this topic