SELECT Assessment_New.M1040_Influ,Assessment_New.Assessment_ID, Assessment_New.Assessment_Completed_M0090, Assessment_New.Date_Discharge_M0906, Assessment_New.Start_of_Care_M0030, Assessment_New.When_Confused_M0570 , 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_e_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.Urinary_INcont_M0520, Assessment_New.Resp_Treatments_M0500, Assessment_New.Freq_of_Pain_M0420, Assessment_New.Surgical_ICD_485, Assessment_New.Surgical_ICD_Date_485, Assessment_New.Surgical_ICD_485_Description, Assessment_New.UTI_M0510, Assessment_New.Assessment_note, Assessment_New.Assessment_Tracker_ID FROM #Request.prefix_db_agency#.Assessment_New WHERE Assessment_New.Assessment_ID='#session.cs.AssessmentId#' SELECT Patient_ID, Last_Name_M0040 AS Last_Name, First_Name_M0040 AS First_Name, Middle_Initial_M0040 AS Middle ,Payer_ID FROM #Request.prefix_db_agency#.patient WHERE Patient_Id = '#session.cs.patientid#' AND Agency_Id = '#session.AgencyId#'


#GetP.First_Name# #GetP.Last_Name#, Ped - Pediatric Evaluation	0% done

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Vital

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Type	Temperature Heart Rate Respiratory Rate Blood Pressure Systolic Blood Pressure Diastolic Blood Sugar Level Weight Height Pain (scale 1-10) Abdominal Girth Head Circumference O2 Saturation

Reading

Severity	0 asymptomatic 1 well-controlled 2 controlled with difficulty 3 poorly controlled 4 hx hospitalizations

Notes

Diagnosis Select

Diagnosis

Primary?

Yes No

Secondary?

Yes No

Onset or Exacerbation

(O) (E)

*SEVERITY KEY

0 - Asymptomatic, no treatment needed

1 - Symptoms well controlled

2 - Symptoms controlled with difficulty

3 - Symptoms poorly controlled

4 - history of rehospitalizations

Severity level

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