Patient Entries
General Patient Information General Patient Information
Patient's first name. Required.
Patient's last name. Required.
Patient's diagnosis. Required.
Gestational Age with at least 1 numerical character. Required.
weeks days
Corrected Gestational Age with at least 1 numerical character. Required.
Day of Life with at least 1 numerical character. Required.
Day the patient was born. Required.
The time the patient was born. Required.
The weight of the patient at the time of birth. Required.
The current weight of the patient. Required.
The kaiser score of the patient. Required.
The blood type of the patient. Required.
Coombs test results. Required.
Acuity of the patient. Required.
The patients bed number. Required.
Date and time the patient was admitted. Required.
Date and time the patient was discharged. Not Required.
Maternal/Delivery Information Maternal/Delivery Information
How many pregnancies mother has had. Required.
How many deliveries mother has had. Required.
Age of mother. Required.
Vaginal or C-Section birth. Required.
Patients APGAR score. Required.
hours
Rupture of membranes. Not Required.
Maternal history for patient. Required.
The maternal blood type. Required. Consistent.
Assessment Assessment
Head Ultra Sound. Not Required.
RA
VENT
HFNC
VT
CPAP
Respiratory support settings. One Required. Interchangeable.
%
FIO2 Percentage. Required. If RA is selected, FIO2 is 21%.
Apnea Bradycardia/Desaturations/Periodic Breathing. Not Required.

Murmur
ECHO
Checkboxes for murmur and echo. Not Required.
Results text input. Not Required.
Patients medication. Not Required.
Labs/Tests Labs/Tests
CBC
TB
BMP
CRP
TG
Checkbox form for labs/tests. Not Required.
Information regarding the QTu Labs. Not Required.
@
Date and time of trough.If box is checked, required. Consistent
CXR
KUB
Time of Radilogy. Not Required.
Other Tests Other Tests
Check if the patient has Hepatitis B Vaccine. Not Required.
Check if the patient has Newborn Screen, then select date. Not Required.
If pateint has either CCHD/ECHO, then add text. Not Required.
Results
If the patient has had an eye exam, then add date and text. Not Required.
Check if the patient has had a follow up, then add date. Not Required.
If the patient has had hearing test. Not Required.
Check if the patient needs a car seat. Not Required.
Check if the patients parents have watched CPR video. Not Required.
Check if the patient is circumsized. Not Required.
Fluids/Drugs Fluids/Drugs
PIV
PICC
UAC
UVC
Saline Lock
Check what IV fluids patine uses. Not Required.
@
Amount of drugs used per hour. Not Required.
@
Amount of drugs used per hour. Not Required.
@
Amount of drugs used per hour. Not Required.
Notes regarding intake. Not Required.
Diet/Feeding Schedule Diet/Feeding Schedule
Method of feeding. Required.
If patient can be fed as much as they want. Not Required.
If the patient gives cues when hungry. Not Required.
cc/kg/day
Cubic Centimeters Per Kilogram Per Day of food intake. Not Required
Attempted Completed
Feeding attempts with at least 1 numerical character. Not Required.
In Depth Patient Notes In Depth Patient Notes
Text field for Plan of Care. Not Required.
Text field for social considerations. Not Required.
Text field for patient history and changes. Not Required.
Other Other
Text field for referalls. Not Required.
Check if child is using Synagis. Not Required.
Check if child has had 2 month vaccine. Not Required.
Text field for patients Pediatrician. Not Required.
Date for the patients last bath. Not Required.
Consent
HUS
Date Time
Cooling patient information. Not required.
Phototherapy for patient. Not Required.