I want to own my own daycare for kids with special needs.

New Patient Supporting Documents for the Pulmonary Clinic


Diagnosis /Symptom: Asthma, Recurrent Cough or Wheeze

What should the referring provider send?

  1. A complete list of all medications
  2. Medical records regarding relevant past evaluation and treatment, including:
    • Previous medical records related to the reason for consultation including relevant
    • ED/hospitalizations, clinic notes, and medication history or attempted therapeutic interventions
    • Medical history since birth (summary) including growth chart
    • Copy of any pulmonary function testing
    • All lab results pertaining to the problem including allergy testing
    • CD of any chest radiographs/imaging
    • Other key pieces of information…

Diagnosis /Symptom: Bronchopulmonary Dysplasia, Chronic Lung Disease

What should the referring provider send?

  1. A complete list of all medications
  2. Medical records regarding relevant past evaluation and treatment, including:
    • History including birth history including NICU course and respiratory history since birth
    • SpO2 values
    • Echocardiograms
    • Growth chart
    • CD of chest radiographs
    • Current treatments
    • Current supplemental oxygen requirement
    • Copy of any pulmonary function testing
    • Other key pieces of information…

Diagnosis /Symptom: Cystic Fibrosis

What should the referring provider send?

  1. A complete list of all medications
  2. Medical records regarding relevant past evaluation and treatment, including:
    • Copy of genotype/sweat chloride test results
    • Growth chart (weight, length, BMI)
    • Copy of annual CF labs
    • Copy of respiratory culture results
    • Copy of pulmonary function testing and trends
    • Copy of recent home healthcare plan from clinic
    • CD of most recent chest radiographs/CTs or relevant imaging
    • Other key pieces of information…

     

Diagnosis /Symptom: Sleep Disorders

What should the referring provider send?

  1. A complete list of all medications including OTC medications
  2. Medical records regarding relevant past evaluation and treatment, including:
    • Pertinent history and physical
    • Growth chart
    • Recent lab results
    • Prior ENT evaluations, sleep evaluations or sleep studies
    • Sleep log for 2 weeks (time to bed, time of naps, time wakes up)
    • Interventions tried
    • For insomnia/restless sleep, ferritin level
  3. Other key pieces of information…