WAVE 3 - Injury Plus SEEK Baseline Data Review Question Title * 1. Please choose the practice for this data review. 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 Question Title * 2. Provider name for this chart: Question Title * 3. For the chart reviewed and being entered, in which month did the well visit occur? December 2020 January 2021 Other Question Title * 4. What was the age of the child at this visit? Birth - 12 months of age 18 months - 5 years of age Other Question Title * 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 Tobacco Use Screening documented Tobacco Use Discussion (general) Tobacco Use Discussion (for positive screening) Tobacco Use Resources provided (such as a handout) Tobacco Use Referral provided (to a service provider) Tobacco Use No documentation of this topic Drug or Alcohol Use Drug or Alcohol Use Screening documented Drug or Alcohol Use Discussion (general) Drug or Alcohol Use Discussion (for positive screening) Drug or Alcohol Use Resources provided (such as a handout) Drug or Alcohol Use Referral provided (to a service provider) Drug or Alcohol Use No documentation of this topic Food Insecurity Food Insecurity Screening documented Food Insecurity Discussion (general) Food Insecurity Discussion (for positive screening) Food Insecurity Resources provided (such as a handout) Food Insecurity Referral provided (to a service provider) Food Insecurity No documentation of this topic Social Needs (Housing, employment, etc.) Social Needs (Housing, employment, etc.) Screening documented Social Needs (Housing, employment, etc.) Discussion (general) Social Needs (Housing, employment, etc.) Discussion (for positive screening) Social Needs (Housing, employment, etc.) Resources provided (such as a handout) Social Needs (Housing, employment, etc.) Referral provided (to a service provider) Social Needs (Housing, employment, etc.) No documentation of this topic Domestic Violence Domestic Violence Screening documented Domestic Violence Discussion (general) Domestic Violence Discussion (for positive screening) Domestic Violence Resources provided (such as a handout) Domestic Violence Referral provided (to a service provider) Domestic Violence No documentation of this topic Maternal Depression Maternal Depression Screening documented Maternal Depression Discussion (general) Maternal Depression Discussion (for positive screening) Maternal Depression Resources provided (such as a handout) Maternal Depression Referral provided (to a service provider) Maternal Depression No documentation of this topic Stress/Parenting Difficulties Stress/Parenting Difficulties Screening documented Stress/Parenting Difficulties Discussion (general) Stress/Parenting Difficulties Discussion (for positive screening) Stress/Parenting Difficulties Resources provided (such as a handout) Stress/Parenting Difficulties Referral provided (to a service provider) Stress/Parenting Difficulties No documentation of this topic Question Title * 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 Furniture tip overs Screening documented Furniture tip overs Discussion (general) Furniture tip overs Discussion (for positive screening) Furniture tip overs Resources provided (such as a handout) Furniture tip overs Referral provided (to a service provider) Furniture tip overs No documentation of this topic Stair and/or window safety Stair and/or window safety Screening documented Stair and/or window safety Discussion (general) Stair and/or window safety Discussion (for positive screening) Stair and/or window safety Resources provided (such as a handout) Stair and/or window safety Referral provided (to a service provider) Stair and/or window safety No documentation of this topic Choking risks Choking risks Screening documented Choking risks Discussion (general) Choking risks Discussion (for positive screening) Choking risks Resources provided (such as a handout) Choking risks Referral provided (to a service provider) Choking risks No documentation of this topic Car seat safety Car seat safety Screening documented Car seat safety Discussion (general) Car seat safety Discussion (for positive screening) Car seat safety Resources provided (such as a handout) Car seat safety Referral provided (to a service provider) Car seat safety No documentation of this topic Water safety Water safety Screening documented Water safety Discussion (general) Water safety Discussion (for positive screening) Water safety Resources provided (such as a handout) Water safety Referral provided (to a service provider) Water safety No documentation of this topic Smoke and/or CO detectors Smoke and/or CO detectors Screening documented Smoke and/or CO detectors Discussion (general) Smoke and/or CO detectors Discussion (for positive screening) Smoke and/or CO detectors Resources provided (such as a handout) Smoke and/or CO detectors Referral provided (to a service provider) Smoke and/or CO detectors No documentation of this topic Poison prevention Poison prevention Screening documented Poison prevention Discussion (general) Poison prevention Discussion (for positive screening) Poison prevention Resources provided (such as a handout) Poison prevention Referral provided (to a service provider) Poison prevention No documentation of this topic Firearms safety Firearms safety Screening documented Firearms safety Discussion (general) Firearms safety Discussion (for positive screening) Firearms safety Resources provided (such as a handout) Firearms safety Referral provided (to a service provider) Firearms safety No documentation of this topic Life saving techniques (CPR, first-aid, etc.) Life saving techniques (CPR, first-aid, etc.) Screening documented Life saving techniques (CPR, first-aid, etc.) Discussion (general) Life saving techniques (CPR, first-aid, etc.) Discussion (for positive screening) Life saving techniques (CPR, first-aid, etc.) Resources provided (such as a handout) Life saving techniques (CPR, first-aid, etc.) Referral provided (to a service provider) Life saving techniques (CPR, first-aid, etc.) No documentation of this topic Done