Get the free Cc481 Initial Pediatric Intake Form - Swedish Hospital

Initial Pediatric Intake Form Swedish Pediatrics Pediatric Health History Today's Date: / / Child's Name: Child's Date of Birth: / / Child's Age: Last First MI Preferred NICKNAME for child? Parents

How to fill out cc481 initial pediatric intake

How to fill out cc481 initial pediatric intake:

1. Start by gathering all necessary information about the pediatric patient, such as their personal details, medical history, and any existing conditions or allergies they may have.
2. Fill out the patient's name, date of birth, and gender in the appropriate sections of the cc481 form.
3. Provide the patient's contact information, including their address, phone number, and emergency contact details.
4. Indicate the primary language spoken by the patient and if they require any translation services.
5. Document the patient's medical history, including any previous surgeries, hospitalizations, or chronic illnesses they have experienced.
6. List any allergies or adverse drug reactions the patient may have, including the specific medications or substances they are allergic to.
7. Describe the patient's current medications, including the dosage and frequency of each medication.
8. Record the patient's immunization history, including the dates and types of vaccines received.
9. Document any current symptoms or concerns that the patient or their guardian has regarding their health.
10. Provide any additional information or relevant documents, such as referral letters or lab results.
11. Review the completed cc481 form for accuracy and make sure all required fields have been filled out.
12. Sign and date the form to certify its completion.

Who needs cc481 initial pediatric intake:

1. Pediatric patients who are new to a healthcare facility or provider may need to fill out the cc481 initial pediatric intake form.
2. The cc481 form helps gather important information about the patient's medical history, current health status, and contact details.
3. Healthcare providers, including doctors, nurses, and pediatric specialists, use the cc481 form to assess and provide appropriate care to pediatric patients.

For pdfFiller’s FAQs

What is cc481 initial pediatric intake?

CC481 initial pediatric intake is a form used to collect information about the initial health status of pediatric patients.

Who is required to file cc481 initial pediatric intake?

Healthcare providers and facilities are required to file cc481 initial pediatric intake for pediatric patients.

How to fill out cc481 initial pediatric intake?

CC481 initial pediatric intake can be filled out by healthcare professionals using the provided template with accurate information about the patient's health.

What is the purpose of cc481 initial pediatric intake?

The purpose of CC481 initial pediatric intake is to document the initial health status of pediatric patients for healthcare records and treatment planning.

What information must be reported on cc481 initial pediatric intake?

Information such as patient demographics, medical history, current health issues, medications, and allergies must be reported on CC481 initial pediatric intake.

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