| ...has trouble comunicating... | |
| ...able to exspress himself... | |
| ...[medical condition] uteris, pregancy was difacalt... | |
| ...whent home from hospital... | |
| ...was with dad and Father has not giving me any of paper work... |
Thank your doctor, they have to see this every day
These are direct quotes from various medical intake forms. They are from multiple practices in multiple locations. Patient identities have not been compromised.
Submissions are always welcome.
Submissions are always welcome.
1| Question: | Please describe any problems with the pregnancy or delivery. |
|---|---|
| Answer: | None. Anemia. |
| Yes | |
| No | |
| ✔ | |
| Induced three weeks early | |
| Normal | |
| ? | |
| 39 weeks and 5 days | |
| [blank] | |
| 2 weeks over do | |
| 385 | |
| Full term |
| Question: | Has the child every witnessed domestic violence or been otherwise abused? If yes, please explain. |
|---|---|
| Answer: | domestik violence |
| Question: | Gestational age at delivery? |
|---|---|
| Answer: | 385 |
| Question: | Please list medications used for more than two weeks |
|---|---|
| Answer: | Yes |
| Question: | Birth weight? _____ lbs _____ oz |
|---|---|
| Answer: | 5 lbs 16 ounces |
