SELECT patient.Last_Name_M0040 AS Last_Name, patient.First_Name_M0040 AS First_Name, patient.Middle_Initial_M0040 AS Middle, Assessment_New.Assessment_Completed_M0090, Assessment_New.Surgical_ICD_485_Description, Assessment_New.Vision_M0390, Assessment_New.Hearing_M0400, Assessment_New.Speech_M0410, Assessment_New.Open_Wounds_M0440, Assessment_New.Pressure_Ulcer_M0445, Assessment_New.Pressure_Ulcer_a_M0450, Assessment_New.Pressure_Ulcer_b_M0450, Assessment_New.Pressure_Ulcer_c_M0450, Assessment_New.Pressure_Ulcer_d_M0450, Assessment_New.Pressure_Ulcer_Stage_M0460, Assessment_New.Stasis_Ulcer_Num_M0470, Assessment_New.Stasis_Ulcer_Hidden_M0474, Assessment_New.Stasis_Ulcer_Status_M0476, Assessment_New.Surgical_Wound_M0482, Assessment_New.Surgical_Wound_OB_M0484, Assessment_New.Surgical_Wound_Status_M0488, Assessment_New.Breathing_M0490, Assessment_New.Resp_Treatments_M0500, Assessment_New.Urinary_INcont_M0520, Assessment_New.Urinary_INcont_when_M0530, Assessment_New.UTI_M0510, Assessment_New.Cog_Function_M0560, Assessment_New.Assessment_note, Assessment_New.Freq_of_Pain_M0420, Assessment_New.Record_Created_By FROM #Request.prefix_db_agency#.Assessment_New INNER JOIN #Request.prefix_db_agency#.patient ON (Assessment_New.Patient_ID=patient.Patient_ID) WHERE Assessment_New.Assessment_ID='#session.cs.AssessmentId#' select Diagnosis_ID,Diagnosis,Short_Diagnosis,Text_ICD,Severity,CONVERT(Diagnosis.Dx_Order, CHAR(10)) as Dx_Order,Primary_Diagnosis,Secondary_Diagnosis,DG_Type from #Request.prefix_db_agency#.Diagnosis where Assessment_ID='#session.cs.AssessmentId#' and M0230_Link like '%M0230%' and M0230_Link is not null order by Dx_Order asc opacity = "header opacity" topmargin = "value of the top margin of the header" \\one of the following: destination = "PDF output file pathname" name = "PDF document variable name" text = _PAGELABEL: add current page label|_LASTPAGELABEL: add last page label| _PAGENUMBER: add current page number|_LASTPAGENUMBER: add last page number \\text for the header. You can also add a normal text string. image = "image file name to be used as the header" --->

#session.agencyname#	Date Completed #DateFormat(Form.Assessment_Completed_M0090,"mm/dd/yyyy")#
Pediatric Evaluation	By #Form.Record_Created_By#
#Form.First_Name# #Form.Last_Name#

Diagnoses #Diagnosis# Procedures #replace('#Form.Surgical_ICD_485_Description#',',',' ',"ALL")# #replace('#Form.Surgical_ICD_485_Description#','!',' ',"ALL")# Length at birth #Form.Vision_M0390# Weight at birth #Form.Hearing_M0400# APGARS #Form.Speech_M0410# Skin #replace('#Form.Open_Wounds_M0440#',',',' ',"ALL")# #replace('#Form.Open_Wounds_M0440#','!',' ',"ALL")# Head and Neck #replace('#Form.Pressure_Ulcer_M0445#',',',' ',"ALL")# #replace('#Form.Pressure_Ulcer_M0445#','!',' ',"ALL")# Eyes #replace('#Form.Pressure_Ulcer_a_M0450#',',',' ',"ALL")# #replace('#Form.Pressure_Ulcer_a_M0450#','!',' ',"ALL")# Ears #replace('#Form.Pressure_Ulcer_b_M0450#',',',' ',"ALL")# #replace('#Form.Pressure_Ulcer_b_M0450#','!',' ',"ALL")# Mouth and Throat #replace('#Form.Pressure_Ulcer_c_M0450#',',',' ',"ALL")# #replace('#Form.Pressure_Ulcer_c_M0450#','!',' ',"ALL")# Nose #replace('#Form.Pressure_Ulcer_d_M0450#',',',' ',"ALL")# #replace('#Form.Pressure_Ulcer_d_M0450#','!',' ',"ALL")# Gastrointestinal #replace('#Form.Pressure_Ulcer_Stage_M0460#',',',' ',"ALL")# #replace('#Form.Pressure_Ulcer_Stage_M0460#','!',' ',"ALL")# Genitourinary #replace('#Form.Stasis_Ulcer_Num_M0470#',',',' ',"ALL")# #replace('#Form.Stasis_Ulcer_Num_M0470#','!',' ',"ALL")# Female #replace('#Form.Stasis_Ulcer_Hidden_M0474#',',',' ',"ALL")# #replace('#Form.Stasis_Ulcer_Hidden_M0474#','!',' ',"ALL")# Male #replace('#Form.Stasis_Ulcer_Status_M0476#',',',' ',"ALL")# #replace('#Form.Stasis_Ulcer_Status_M0476#','!',' ',"ALL")# Nutrition #replace('#Form.Surgical_Wound_M0482#',',',' ',"ALL")# #replace('#Form.Surgical_Wound_M0482#','!',' ',"ALL")# Endocrine #replace('#Form.Surgical_Wound_OB_M0484#',',',' ',"ALL")# #replace('#Form.Surgical_Wound_OB_M0484#','!',' ',"ALL")# Musculo-Skeletal #replace('#Form.Surgical_Wound_Status_M0488#',',',' ',"ALL")# #replace('#Form.Surgical_Wound_Status_M0488#','!',' ',"ALL")# Cardiovascular #replace('#Form.Breathing_M0490#',',',' ',"ALL")# #replace('#Form.Breathing_M0490#','!',' ',"ALL")# Neurological ',"ALL")> #replace('#Form.Resp_Treatments_M0500#',',',' ',"ALL")# ',"ALL")> #replace('#Form.Resp_Treatments_M0500#','!',' ',"ALL")# Respiratory ',"ALL")> #replace('#Form.Urinary_INcont_M0520#',',',' ',"ALL")# ',"ALL")> #replace('#Form.Urinary_INcont_M0520#','!',' ',"ALL")# Pain ',"ALL")> #replace('#Form.Freq_of_Pain_M0420#',',',' ',"ALL")# ',"ALL") > #replace('#Form.Freq_of_Pain_M0420#','!',' ',"ALL")# Infusion ',"ALL")> #replace('#Form.UTI_M0510#',',',' ',"ALL")# ',"ALL") > #replace('#Form.UTI_M0510#','!',' ',"ALL")# Infusion Notes ',"ALL") > #replace('#Form.Cog_Function_M0560#',',',' ',"ALL")# ',"ALL") > #replace('#Form.Cog_Function_M0560#','!',' ',"ALL")# General Assessment #Form.Assessment_note# Physician Signature: ____________________________________________________

Page #cfdocument.currentpagenumber# Pediatric Evaluation for #Form.First_Name# #Form.Last_Name#