FMO & Moreno Valley Pediatrics
WCC / AG / HEBA
Clinic Notes
- Adult Visit: Non-Teaching Version | Teaching Version
- Ancillary Test Sheet
- Anticoagulant (Coumadin) Record Sheet
- Circumcision Packet
- Consents / Authorizations:
- Consult Note
- Diabetes Log
- Flowsheet, Patient Visit
- Information / Demographics Page
- New Pediatric History Sheet
- Nurse Visit
- Phone Messages / Prescription Refills Note
- Progress Notes:
NOTE: Office staff may only complete "Reason for Visit"
| Attending Only | With Resident | |
| Generic Note #1 | Generic Note #1 | Comments BELOW the physical exam |
| Generic Note #2 | ----- | Comments RIGHT of physical exam |
| Asthma Note | Asthma Note | |
| Packet | Packet | With Patient Education and Action Plan |
| Physician Assistant Note | ||
- Student Note
- TB Risk Assessment - Patient Form: English | Spanish
- Vaccines:
- Vaccine Administration Record Sheet
- UHC EHR VIS Consent Form (Revised 4/2020)
- Flu Vaccine Consent: English
- Live Attenuated Influenza Vaccine (LAIV) Consent
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