NEW PATIENT RECORD - Pediatrics Around The Bend 2026

1. Click ‘Get Form’ to open the NEW PATIENT RECORD in the editor.
2. Begin by entering the date at the top of the form, followed by the patient's name and date of birth (DOB). Ensure accuracy as this information is crucial for identification.
3. In the 'Birth History' section, provide details about the hospital where the child was born, any complications or toxic exposures, and select feeding methods (Breast/Bottle/Both). Indicate if under lights treatment was required and specify delivery type (Vaginal/Cesarean) along with gestational age.
4. Fill in past medical history. If there are no hospitalizations since birth, check the corresponding box. Otherwise, list reasons and dates for any hospital visits, major illnesses, surgeries, and specialists involved in care.
5. Document current prescription medications by listing each medication's name, dose, frequency, and reason. If there are no medications, check the appropriate box.
6. In the allergies section, note any known allergies to medications or foods. Again, check if none apply.
7. Complete the social history section by indicating who lives at home with the patient and answering questions about pets, school/daycare attendance, recent travel, smoking status in the household, and gun safety measures.
8. Finally, ensure that a physician reviews all provided information before submission.

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