Children'S Special Health Services Flow Sheet Page 3
ADVERTISEMENT
1
2
3DHHS 2809 (cont)
18.
SPECIAL THERAPIES
Record any speech, occupational, physical, nutrition
therapies; Child Service Coordination, Early Intervention,
Special Education this patient receives.
19.
DURABLE MEDICAL
Record any special equipment the patient needs or uses on
EQUIPMENT
a regular basis and any repair needed for that equipment.
20.
SIGNATURE
Record the full legal signature of the health professional
responsible for the above information.
21.
EDUCATION/COUNSELING
Record education/counseling provided for each diagnosis
PROVIDED
and treatment including clinical findings; treatments; and
special therapies.
22.
REFERRALS
Record by type or name, referrals to other health care
providers, agencies, or immunizations.
23.
DATE OF NEXT VISIT
Record the date given to the patient for the next
scheduled visit.
24.
SIGNATURE
Record the full legal signature of the health professional
responsible for the information in items 20-22.
52
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Medical