Zachary LaFontaine Visit Shadow health Objective data
Objective Data Collection: 24.33 of 25 (97.32%)
Correct
Partially correct
Incorrect
Missed
Growth Chart: Head Circumference
1 of 1 point
Head Circumference Percentile
(1/2 point)
Below 5th percentile
Between 5th and 95th percentile
Above 95th percentile
Head Circumference Growth Curve
(1/2 point)
Growth curve maintained
Growth curve decline
Zachary LaFontaine Visit Shadow health Objective data
Growth Chart: Weight and Length
0.83 of 1 point
Length Percentile
(1/6 point)
Below 5th percentile
Between 5th and 95th percentile
Above 95th percentile
Length Growth Curve
(1/6 point)
Growth curve maintained
Growth curve decline
Weight Percentile
(1/6 point)
Below 5th percentile
Between 5th and 95th percentile
Above 95th percentile
Weight Growth Curve
(No point)
Growth curve maintained
Growth curve decline
Weight For Length Percentile
(1/6 point)
Below 5th percentile
Between 5th and 95th percentile
Above 95th percentile
Weight For Length Growth Curve
(1/6 point)
Growth curve maintained
Growth curve decline
Zachary LaFontaine Visit Shadow health Objective data
Inspected Nose
1 of 1 point
Nares Inspection
(1/3 point)
Pale
Pink
Erythematous
Mucus
(1/3 point)
Thin white mucus present
Thick yellow mucus present
Nares
(1/3 point)
Patent
Obstructed, not patent single sided
Inspected Ears
1 of 1 point
Inspection
(1/2 point)
Ears set appropriately
Ears low set, posteriorly rotated
Pinna
(1/2 point)
Pinna flexible
Pinna stiff
Inspected Mouth
1 of 1 point
Frenulum
(1/4 point)
Frenulum intact
Frenulum thick
Palate
(1/4 point)
Palate intact
Palate open
Tongue
(1/4 point)
Tongue smooth
Zachary LaFontaine Visit Shadow health Objective data
Tongue rough
Uvula
(1/4 point)
Uvula midline
Uvula absent
Inspected Skin
1 of 1 point
Color
(1/8 point)
Cyanosis
Jaundice
Pallor
Congruent with genetic background
Texture
(1/8 point)
Smooth
Rough
Temperature
(1/8 point)
Warm
Cool
Skin Hydration
(1/8 point)
Elastic
Tenting
Sluggish turgor
Lesions
(1/8 point)
No visible lesions
Laceration/wounds
Erythema
Ecchymosis
Birthmark
Discolorations
Mucous Membrane: Hydration
(1/8 point)
Moist
Dry
Mucous Membrane: Appearance
(1/8 point)
Intact
Cracked
Blistered
Zachary LaFontaine Visit Shadow health Objective data
Mucous Membrane: Color
(1/8 point)
Pink
Pale
Erythematous
Inspected Diaper Area
1 of 1 point
Inspect Skin Diaper Area
(1/1 point)
No lesions present
Macerated
Edema
Erythema
Inspected Genitalia
1 of 1 point
Appearance
(1/5 point)
Urethral meatus midline
Hypospadias
Ambiguous genitalia
Palpation
(1/5 point)
Testes present bilaterally
Testes not palpable
Rugae
(1/5 point)
Smooth
Rough
Masses
(1/5 point)
No masses
Mass palpable
Swelling
Circumcision
(1/5 point)
Circumcised
Uncircumcised
Assessed Musculoskeletal: Barlow and Ortolani
1 of 1 point
Barlow
(1/2 point)
Positive
Negative
Ortolani
(1/2 point)
Positive
Negative
Assessed Eyes: Pupils
1 of 1 point
Shape
(1/3 point)
Round
Zachary LaFontaine Visit Shadow health Objective data
Abnormal shape
Light Reaction
(1/3 point)
No reaction to light
Reacts to light symmetrically
Reacts to light asymmetrically
Opacity
(1/3 point)
Clear
Cloudy
Assessed Eyes: Red Reflex
1 of 1 point
Red Reflex
(1/3 point)
Absent
Present
Color
(1/3 point)
Equal color bilaterally
Unequal color bilaterally
Opacity
(1/3 point)
Opacity absent
Opacity present
Assessed Eyes: Tracking
1 of 1 point
Vision Screening
(1/1 point)
Follows object in both directions
Does not follow object in both directions
Zachary LaFontaine Visit Shadow health Objective data
Assessed Extremities
1 of 1 point
Movement
(1/2 point)
Moves all extremities
Does not move all extremities
Symmetry
(1/2 point)
Movement symmetrical
Movement asymmetrical
Zachary LaFontaine Visit Shadow health Objective data
Assessed Grasp
1 of 1 point
Grasp
(1/3 point)
Intact
Not Evident
Tone
(1/3 point)
Strong
Weak
Symmetry
(1/3 point)
Symmetrical
Asymmetrical
Absent
Assessed Moro Reflex
1 of 1 point
Moro Reflex
(1/2 point)
Normal Response
Weak response
Absent response
Hearing
(1/2 point)
Hearing intact
Hearing absent
Assessed Tonic Reflex
1 of 1 point
Neck Range Of Motion
(1/2 point)
Symmetrical
Asymmetrical
Absent
Tonic Reflex
(1/2 point)
Present
Absent
Zachary LaFontaine Visit Shadow health Objective data
Assessed Pulse
1 of 1 point
Pulse
(1/2 point)
Regular
Irregular
Amplitude
(1/2 point)
Equal bilaterally
0
+1
+2
+3
Assessed Rooting Reflex
1 of 1 point
Rooting Reflex
(1/1 point)
Normal response
Weak response
Absent response
Assess Sucking Reflex
1 of 1 point
Sucking Reflex
(1/2 point)
Normal response
Weak response
Absent response
Tongue Range Of Motion
(1/2 point)
Normal response
Absent response
Zachary LaFontaine Visit Shadow health Objective data
Assessed Neurological: Stepping/Walking Reflex
1 of 1 point
Stepping Relfex
(1/1 point)
Present
Absent
Palpated Abdomen
1 of 1 point
Light Palpation
(1/2 point)
Soft
Firm
Distended
Mass
Bulges
Tenderness
(1/2 point)
Nontender
Tender
Palpated Fontanelles
1 of 1 point
Anterior
(1/2 point)
Sunken
Flat
Bulging
Posterior
(1/2 point)
Sunken
Flat
Bulging
Zachary LaFontaine Visit Shadow health Objective data
Auscultated Abdomen
0.5 of 1 point
Appearance
(No point)
Protuberant
Flat
Scaphoid
Auscultation
(1/2 point)
Absent
Hypoactive
Normoactive
Hyperactive
Auscultated Heart
1 of 1 point
Rate
(1/3 point)
Regular Rate
Irregular Rate
Rhythm
(1/3 point)
Regular rhythm
Arrhythmia
Heart Sounds
(1/3 point)
S1
S2
S3
S4
Murmurs
Auscultated Lungs
1 of 1 point
Appearance
(1/3 point)
Symmetrical chest rise
Asymmetrical chest rise
Breath Sounds
(1/3 point)
Clear to auscultation
Wheezing
Stridor
Grunting
Absent
Respiratory Effort
(1/3 point)
Smooth, even respirations
Nasal flaring
Retractions
Zachary LaFontaine Visit Shadow health Objective data
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