care notebook - the center for children with...
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CARE NOTEBOOK Center for Children with Special Needs, Seattle Children's For more copies, visit www.cshcn.org 2/15 Washington State Department of Health, Children with Special Health Care Needs Program
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CARE NOTEBOOK Center for Children with Special Needs, Seattle Children's For more copies, visit www.cshcn.org 2/15 Washington State Department of Health, Children with Special Health Care Needs Program
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CARE NOTEBOOK Center for Children with Special Needs, Seattle Children's For more copies, visit www.cshcn.org 2/15 Washington State Department of Health, Children with Special Health Care Needs Program
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CARE NOTEBOOK Center for Children with Special Needs, Seattle Children's For more copies, visit www.cshcn.org 2/15 Washington State Department of Health, Children with Special Health Care Needs Program
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CARE NOTEBOOK Center for Children with Special Needs, Seattle Children's For more copies, visit www.cshcn.org 2/15 Washington State Department of Health, Children with Special Health Care Needs Program
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CARE NOTEBOOK Center for Children with Special Needs, Seattle Children's For more copies, visit www.cshcn.org 2/15 Washington State Department of Health, Children with Special Health Care Needs Program
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CARE NOTEBOOK Center for Children with Special Needs, Seattle Children's For more copies, visit www.cshcn.org 2/15 Washington State Department of Health, Children with Special Health Care Needs Program
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CARE NOTEBOOK
For more copies, visit www.cshcn.org 2/15
Center for Child with Special Needs Seattle Children’s Washington State Department of Health, Children with Special Health Care Needs Program
2/7/15 Neurology, Dr. Roza EEG. Went over seizure and sleep tracking sheets
Call in May to
schedule next
appointment
206 987-2201 Example
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CARE NOTEBOOK Center for Children with Special Needs, Seattle Children's For more copies, visit www.cshcn.org 2/15 Washington State Department of Health, Children with Special Health Care Needs Program
Example:
3/15-3/20/15 ICU, then moved to floor Respiratory infection
Dr. Walls talked with us about new
treatment plan. We will discuss at
our clinic appointment
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LAST NAME FIRST NAME M.I. BIRTHDATE (mm/dd/yy)
[42]
MEDICAL NOTES (allergies, vaccine reactions, etc.)
Vaccine TypeDate
Given
(m/d/yy)
Administered By
(clinic, doctor, etc)
Next Dose
Date Vaccine TypeDate
Given
(m/d/yy)
Administered By
(clinic, doctor, etc)
Next Dose
Date
Hepatitis B Hepatitis A
(HepA, HepA-HepB)
Meningococcal
(MCV4, MPSV4)
Human papillomavirus
(HPV4, HPV2)
Zoster (shingles)
boosters
Influenza (yearly)
(TIV, LAIV)
Pneumococcal
(PCV7, PCV13, PPSV23)
Other
Polio
Rotavirus
Measles, Mumps, & [42]
Rubella (MMR, MMRV)
Varicella (chickenpox)
(VAR, MMRV)
(HepB, Hib-HepB, HepA-
HepB, DTaP-HepB-IPV)
Diptheria, Tetanus,
Pertussis
(DTaP, DTP, DT, Td, Tdap,
DTaP-HepB-IPV, DTaP-
IPV/Hib, DTaP-IPV,
DTaP/Hib)
Haemophilus
influenzae type b
Immunization Record
(Hib, Hib-HepB, DTaP-
IPV/Hib, DTaP/Hib)
(IPV, OPV, DTaP-HepB-
IPV, DTaP-IPV/Hib, DTaP-
IPV)
(RV1, RV5, RV [unknown])
http://www.vertex42.com/ExcelTemplates/immunization-schedule.html
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CARE NOTEBOOK Center for Children with Special Needs, Seattle Children's For more copies, visit www.cshcn.org 2/15 Washington State Department of Health, Children with Special Health Care Needs Program
Example:
8 am Flush feeding tube MB
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CARE NOTEBOOK Center for Children with Special Needs, Seattle Children's For more copies, visit www.cshcn.org 2/15 Washington State Department of Health, Children with Special Health Care Needs Program
Ex: Peanuts Hives 12/1/14
Ex: Wool Rash 6/18/99
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CARE NOTEBOOK Center for Children with Special Needs, Seattle Children's For more copies, visit www.cshcn.org 2/15 Washington State Department of Health, Children with Special Health Care Needs Program
example
7/12/15
EEG
Want to repeat and do
sleep test
Dr. Russ
Need to keep sleep diary
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CARE NOTEBOOK Center for Children with Special Needs, Seattle Children's For more copies, visit www.cshcn.org 2/15 Washington State Department of Health, Children with Special Health Care Needs Program
Sept 20 Major meltdown in
car, kicking seat Late to swim time, missed lunch, short nap
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CARE NOTEBOOK Center for Children with Special Needs, Seattle Children's For more copies, visit www.cshcn.org 2/15 Washington State Department of Health, Children with Special Health Care Needs Program
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CARE NOTEBOOK Center for Children with Special Needs, Seattle Children's For more copies, visit www.cshcn.org 2/15 Washington State Department of Health, Children with Special Health Care Needs Program
Oatmeal
Cheese
sandwich,
apple,
popcorn
Chicken
nuggets,
broccoli
Ensure
before bed
Carrots at
10 a.m.,
granola bar
at 4 p.m.
Still dislikes
the
strawberry
ensure
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CARE NOTEBOOK Center for Children with Special Needs, Seattle Children's For more copies, visit www.cshcn.org 2/15 Washington State Department of Health, Children with Special Health Care Needs Program
3 months Couldn’t stop smiling
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CARE NOTEBOOK Center for Children with Special Needs, Seattle Children's
For more copies, visit www.cshcn.org Washington State Department of Health, Children with Special Health Care Needs Program
2/15
3/9/2013 10:42
a.m.
Jenn from
Seattle
Children’s PT
Confirming that
Benny is wearing
his cast
Reassured Jenn that
he is, she will check
back in 1 week
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CARE NOTEBOOK Center for Children with Special Needs, Seattle Children's For more copies, visit www.cshcn.org 2/15 Washington State Department of Health, Children with Special Health Care Needs Program
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Daily Medication Tracking SheetDate Child's Name:
Medication Medication Medication Medication Medication Medication Medication
Dosage
How often
Notes
Time
6:00 AM
7:00 AM
8:00 AM
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
5:00 PM
6:00 PM
7:00 PM
8:00 PM
9:00 PM
10:00 PM
11:00 PM
12:00 AM
1:00 AM
2:00 AM
3:00 AM
4:00 AM
5:00 AM
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CARE NOTEBOOK Center for Children with Special Needs, Seattle Children's For more copies, visit www.cshcn.org 2/15 Washington State Department of Health, Children with Special Health Care Needs Program
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CARE NOTEBOOK Center for Children with Special Needs, Seattle Children's For more copies, visit www.cshcn.org 2/15 Washington State Department of Health, Children with Special Health Care Needs Program
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CARE NOTEBOOK Center for Children with Special Needs, Seattle Children's For more copies, visit www.cshcn.org 2/15 Washington State Department of Health, Children with Special Health Care Needs Program
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CARE NOTEBOOK Center for Children with Special Needs, Seattle Children's For more copies, visit www.cshcn.org 2/15 Washington State Department of Health, Children with Special Health Care Needs Program
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CARE NOTEBOOK Center for Children with Special Needs, Seattle Children's For more copies, visit www.cshcn.org 2/15 Washington State Department of Health, Children with Special Health Care Needs Program
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CARE NOTEBOOK Center for Children with Special Needs, Seattle Children's For more copies, visit www.cshcn.org 2/15 Washington State Department of Health, Children with Special Health Care Needs Program
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CARE NOTEBOOK Center for Children with Special Needs, Seattle Children's For more copies, visit www.cshcn.org 2/15 Washington State Department of Health, Children with Special Health Care Needs Program
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© 2008 Seattle Children’s, Seattle, Washington. All rights reserved.
In Case of Emergency
Center
2008
Your Name: Nickname:
Birth Date: Primary Language/Communication:
Home Address:
Parents/Guardians: Relationship: Home #: Other #’s:
Diagnosis:
Medications Dose Time
Allergies:
Emergency Contact: Relationship: Phone #’s:
PHYSICIAN INFORMATION
Primary Doctor: Phone: Fax:
Specialist: Phone: Fax:
Specialist: Phone: Fax:
Insurance:
HOSPITAL INFORMATION
Name: Address:
Phone:
ER Phone: PHARMACY INFORMATION
Name: Address:
Phone:
OTHER
Most Important Things to Know About Me in an Emergency:
Today’s Date: ___________