Child Demographics – This Section to be completed by the ...
Patient Code Number: ... (patient initial)(time of appointment)pnc initials only. ICD 10 Code: Date patient was seen: Complaint/Reason patient stated for visit: Pt. Visit: Foll o. w-up Site of Visit: HP. ASSESSMENT: Food/Nutrition-Related . Hx: (Start to do bullet points now.) Food Allergies/Intolerances: Any? Any changes? Pertinent Meds ... ................
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