SN 1903 User Guide
Contents
1. VVHERE 12 APPT DATE 13 OUTCOME l4 CARD PRESENT 15 MOTHERS AGE AT BIRTH l MARITAL STATUS 17 BIRTH POSITION orde 18 FATHERS OCCUPATION 19 RUBELLA IN PREGNANCY 20 CLINIC ATTENDS Ist YEAR 21 CLINIC ATTENDS 2nd YEAR 22 THEREAFTER 23 CARD PRESENT 24 BIRTH WEI GHT 25 BIRTH TRAUMA 26 HOME VISITS Ist YEAR 27 HOME VISITS 2nd YEAR 28 THEREAFTER 29 FAMILY HISTORY Vim problems 30 HEARING 3l 6 WEEKS 32 6 MONTHS 33 YEAR 34 18 MONTHS 35 2 YEARS 36 3 YEARS 372. DNA 8 DNA conir f 9 No mode 0 Dote of lst App rninev Kept DNA cyes 8 DNA 9 Ta nocppr kep Quteoce of si Aprorntment Gnecorjec 2 vee ogan 3 ANK reapp 4 ANK disch 5 7 DNA eyes DNA c nrrol Na iat MET Further cochon 1 G P 2 Speech Therapy 3 O ner 4 DNA ceses 6 DNA eyes 8 control 9 Qicoos or 2nd Aerea dischorgea 2 see ogan 3 ANKY recep 4 i ANK eneh 5 DNA eyes 8 contro 9 No ato m F r her action I G P 2 Speech Tneropy 3 Oihe DMA cases 5 DNA ea 8 DNA corteo 9 124 on ie Spring 933 Tene goig Cae disshorgea 2 Deod f e3 ONA eyes 8 NA 01 9 No info Clinic Cord Present Yesi 2 non attendance 3 Mother s oge No info 00 DNA odopted 99 Mantal Stotus Single Mamed 2 Separated 3 Divorced 4 Widow 5 No info 0 fuh Order Fother s Occupation Social Clas 1 5 Unemployed 7 DNA single porent 9 No info 0 Rube Recorded Yel No Clinic Attendonces st Year Clinc Altendoncet 2nd Yeor Clinic Attendances H V Cord Present Yal No2 Birthweight Principal birth Trouma Recorded low opgar foetol distress 2 3 prematurity 4 forceps 5 special core 6 joundice 7 twin B Other none recorded Home Visit bt yeor 2nd Yeor Hore Visits mereofer El TL FT L g
3. Reason clear squint or clear acu ty deficiency slight squint or insignificani defect defect lakely have developed recently D K N h history only premature referral for referral failed whisper iest 1 mother s concern 2 history of infectaon 5 refused to co operate 4 wax 5 speech 6 other 7 8 no info i 65 67 6g 6 Diagnosis normal hearing OK but fluid n ear hearing loss no fluid hearing loss and fluid wax scarred ear drum other retracied ear drum hearing loss other non cooperative unable to examine ANK private appt No info 7 Result of first appointment kept 8 9 T me between date of medical 10 Time botwcen date of Summary ischarged no more contact discharged but re referred see again review see again treatment refer to hospital refer to GP other no info ANK normal and discharged still under review still being treated refer to hospital waiting for operation operation done ANK other No info FUN O Mi FUN OM and date of farst appointment weeks first appointment and date seen weeks 1 Cu C Schast Tests SN 1405 CASE CONTROL NAME DOB 2 SEX 3 CASE C ONTROL 4 SCHOOL 5 DATE OF MEDICAL MEASLES 7 G P NUMBER 8 H V NUMBER 9 SAME WORK ADDRESS 10 11 V STON HEARING
4. roten NG PECO DS IN GYZ SECTOR Dec E GWENT 2 PONTYPOOL 3 G NN EBAY VALE 5 R SCA 1 STUDY D CASE CONTROL DATE OF BRTH sex MAE C OOL DATE CF VED CAL AE ASES CODED E NO2 nan 3 G P NUMBER HN N R GPF SLE 255 NO2 PIJON REFERRAL VISIONI HEARING 2 BOTH 3 DNA Control Punci OF PEFERRAL 405 PEFRACTION ORTHOPT CS 2 AUDIOLOGY 3 REF AUD 4 ORTH 6 5 DINA Con 9 13 ViS 1 REFERRALS Da e of kt Hode DNA ess 8 9 Y No appt ree Dee of t Axtertmc hej LRA eur DIA con r gt 9 Na apat 15 Cu b Apes men Di ogoin 3 ANK ie opp 4 NK disc 5 8 con ol No ist le Fur nec ecit n Raf ochen 2 Conultant 5 G P 4 Opticon DNA cases 6 mni DNA euatrol 9 DNA ee s 8 Outcome of Appointment Eze D schor ed 2 see an 3 AN 4 ANK disch 5 De in econd 7 DNA sar l 8 control 9 info 0 Further zct on Cnhopic e rochon 2 Consultant 3 G P 4 Optician 5 DNA caes 6 DNA control 9 ean 8 Situctien Spring 1263 Ces dn cong Coe duchorged 2 Deod file 3 DNA son 8 DSA contr 9 no nfo EAS NG REFERRALS Dale of ht Appointmert
5. t laz While Development Card Present Yes No2 Fom y History Vison Hearirg 2 Both 3 recorded hutoy 4 no info no card 0 Hearing Tes recorded devel cord see ogan 2 nomal 3 no rect d 4 info no card 0 Hearing Test info from other records Referl see 2 3 no record 4 DNA info on devel card 6 Weeks Medicol Development Cord 6 Weeks Medical other cards 6 Months Medical Development Cord 6 Nonths Medical other cords Year devel assessment Development Cord Yeor devel assessment Other Cords 18 Months Medical Development Card 18 Months Medicol Other Cordi 2 Years devel assessment Develcpment Cord 2 Years devel Ciher Cards 3 31 Year Mediol Development Cord 2 31 Yeo Other Cords sa 6o Gi 62 h it 2 Vision 1 Diagnosis Referrals Cases Reason for referral squ nt 1 acuity 2 both 3 watery eye 4 fam ly hastory 5 unable to 6 exam ne lazy eye 7 colour bl ndness Squint normal no review normal but observe slight defect review treatment glasses treatment patch ng no d agnosas ANK Does Not Apply 3 Diagnosis Acuiiy normal no review normal but observe slight defect review treatment glasses treatment patching no diagnosis ANh Does Not Apply N Summary of d agnoses lung
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