DB Column PregnantInterviewRisk.PRC_ID 1f. Have you been to the doctor yet? - Yes This radio button indicates that this woman has started prenatal care. If yes, then enable “Care began after 13th week?” Type Radio Button Required No DB Column InterviewPregnant.PrenatalCareBeganIn 1f. Have you been to the doctor yet? - No This button indicates that this woman has not started prenatal care. Type Button Required No DB Column InterviewPregnant.PrenatalCareBeganIn Care began after 13th week? - Yes This radio button indicates that prenatal care began after the 13th week of gestation. Enabled if “Have you been to the doctor yet?” is Yes. Clear and disable if “Have you been to the doctor yet?” is No. Type Radio Button Required No DB Column InterviewPregnant.CareAfter13WeekIn Care began after 13th week? - No This radio button indicates that prenatal care began before the 13th week of gestation. Enabled if “Have you been to the doctor yet?” is Yes. Clear and disable if “Have you been to the doctor yet?” is No. Type Radio Button Required No DB Column InterviewPregnant.CareAfter13WeekIn
Current Smoking 3b. How many cigarettes do you on an average day now? The text is displayed in the left portion of the main panel to help the user interview in a client-centered way in order to obtain a quality nutrition assessment. Type Text Box Display Only Yes Calculated No DB Column NA Cigarettes/day This text box is associated with current smoking. The user captures information related to smoking during the pregnancy. Type Text Box Required No Length Integer 2 Validation Numeric Display Only No Calculated No DB Column InterviewPregnant.CigarettesPerDayNowNr 3c. Does anyone else living in your household smoke inside the home? - Yes This radio button indicates that someone else within the household smokes. Type Radio Button Required No DB Column InterviewPregnant.HouseholdSmokeIn 3c. Does anyone else living in your household smoke inside the home? - No This radio button indicates that no one else in the household smokes. Type Radio Button Required No DB Column InterviewPregnant.HouseholdSmokeIn
4d. What does your family, friends, or partner say about breastfeeding? The text is displayed in the left portion of the main panel to help the user interview in a client-centered way in order to obtain a quality nutrition assessment. Type Text Box Display Only Yes Calculated No DB Column NA (unlabeled) This is subjective information collected from the interview. The text entered into this text box is displayed in the Subjective portion of the Participant Care Plan. The maximum number of characters allowed is 500. Type Multi Line Text Box Required No Display Only No Calculated No DB Column InterviewPregnant.BFPreparationTextbox2 4e. Tell me the changes you have noticed or concerns you have about your breasts. Listen, ask, and assess for Flat Inverted Pierced Surgeries Pain/discharge Size The text is displayed in the left portion of the main panel to help the user interview in a client-centered way in order to obtain a quality nutrition assessment. Type Text Box Display Only Yes Calculated No DB Column NA 4f. We have moms who have breastfed before and can help you with breastfeeding. I will have one call you. The text is displayed in the left portion of the main panel to help the user interview in a client-centered way in order to obtain a quality nutrition assessment. Display is dependent on whether or not the agency is designated as having BF PC in System Administration. Type Text Box Display Only Yes Calculated No DB Column NA
The Edit and Delete buttons utilize functionality. In the Starters/Prompts text box, display text stored in InterviewStarters.StarterText for InterviewStarter.PartTypeCd +InterviewStarter.SectionCd = “B” + “BFSP”. Breastfeeding/Not Breastfeeding – Health/Medical Note: Breastfeeding Support is not displayed on the Not Breastfeeding Interview. > Assessment > Nutrition Interview <Family Header (See CS Overview)> <Participant Sub-Header (See CS Overview)> Not Breastfeeding Breastfeeding/Not Breastfeeding Breastfeeding/Not Breastfeeding Breastfeeding/Not Breastfeeding Breastfeeding/Not Breastfeeding Breastfeeding Not Breastfeeding Breastfeeding/Not Breastfeeding Control Description
321b - <Risk Description> If this check box is marked, then this risk is auto-assigned during the risk determination process. The Risk Description is defined in System Administration. If Breastfeeding interview, display. Note: Staff would mark the checkbox if they heard about a multifetal gestation with one or more infant deaths for the most recent pregnancy. Type Box Display Only No Calculated No DB Column PPBFInterviewRisk.PRC_ID 311 - <Risk Description> If this check box is marked, then this risk is auto-assigned during the risk determination process. The Risk Description is defined in System Administration. Type Check Box Display Only No Calculated No DB Column PPBFInterviewRisk.PRC_ID 2g. Do you ever have a hard time chewing or eating certain foods? Listen, ask, and assess for Routine oral health care Referral needed decay Tooth loss Impaired ability to eat Gingivitis The text is displayed in the left portion of the main panel to help the user interview in a client-centered way in order to obtain a quality nutrition assessment. Type Text Box Display Only Yes Calculated No DB Column NA
Text box, Z9, Numeric _____ # of pregnancies past 20 weeks/5 months PNSS (live births plus pregnancies past 20 weeks=parity), 333 Date of last birth, abortion, miscarriage Date Picker mm/dd/yyyy Risk 332 1c. Note: If ClinicServices.Assessment.PregIntrvwPRAMSDisplay is set to “No” then this question is not displayed Thinking back to just before you got pregnant with your new baby, how did you feel becoming pregnant? I'm going to read a list of options. Please choose the one that best describes how you felt. List box with values: You wanted to be pregnant sooner You wanted to be pregnant later You wanted to be pregnant then You didn't want to be pregnant then or at any time in the future Include text “(Don't read)” List box with values: Refused Don't know/don't remember (In screen design, these were added to the previous list, not a new list box.) Note for reporting: When we look at coding the question into intendedness, we combine 1 and 3 into intended, and 2 and 4 into unintended. 1d. With any past pregnancy, did you have any complications? 303 - History of gestational diabetes 304 - History of preeclampsia 311 - History of preterm delivery 312 - History of LBW infant 321 - History of miscarriages, spontaneous abortion, neonatal loss 337 - History of LGA 339 - History of congenital defects 345 - History of pregnancy induced hypertension Risks 303, 304, 311, 312, 321, 337, 339, 345
1e. How are you feeling this week? Listen, ask, and assess for Nausea Vomiting Discomfort How do you feel about your weight gain? 301 - Hyperemesis 302 - Gestational Diabetes 301, 302 1f. Have you been to the doctor yet? Radio buttons: Yes No If yes, enable this question. Care after 13th week? buttons: Yes No Risk 334, PNSS 1g. Tell me any medical problems or illnesses you have. Has your doctor diagnosed any medical problems? Listen, ask, and assess for Medical conditions (previous to pregnancy) Health concerns Disability Illnesses Radio buttons: Conditions/No Conditions If Conditions, then enable Medical Conditions Rapport, Process Medical Conditions 347 - Cancer, affects nutritional status– 354 - Celiac disease 348 - Central nervous system disorders <Condition list box> 381 - Dental problems 361 - Depression 362 - Developmental delays, sensory or motor delays interfering with ability to eat 343 - Diabetes mellitus 358 - Eating disorders <Condition list box> 336 - Fetal growth restriction If condition has a checkbox and a list box, the list box is enabled when the user marks the checkbox. I list box selection is then required. Central nervous system disorders list box values: Epilepsy Cerebral palsy (CP) Neural tube defects (NTD), Assign risk based on medical condition marked. specific medical condition to A section of care plan. risks (except 352 and 359) forward to subsequent interviews Risks 301, 302, 303, 311, 312, 321, 336, 337, 339, 341, 342, 343, 344, 345, 346, 347, 348, 349, 351, 352, 353, 354, 355, 356, 357, 358, 359, 360, 361, 362, 381, 901
353 - Food allergies, please list: <Text box>, 100 characters 342 - Gastrointestinal disorder <Condition list box> 349 - Genetic and congenital disorders <Condition list box> 302 - Gestational Diabetes 301 - Hyperemesis - 301 345 - Hypertension 356 - Hypoglycemia 303 - History of Gestational Diabetes 311 - History of preterm delivery 312 - History of LBW infant 321a - History of miscarriages, spontaneous abortion, neonatal loss 337 - History of LGA 339 - History of congenital birth defects 345 - Hypertension 351 - Inborn of metabolism <Condition list box> 352 - Infectious disease, affects nutritional status <Condition list box> 355 - Lactose intolerance, diagnosed 341 - Nutrient deficiency disease <Condition list box> Bifida Myelomeningocele Parkinson’s disease Multiple Sclerosis (MS) Eating disorders list box values: Self-induced vomiting Purgative abuse Use of drugs such as appetite suppressants, thyroid preparations or diuretics Alternating periods of starvation Self-induced marked weight loss Gastrointestinal disorder list box values: Gastroesophageal reflux disease (GERD) Peptic Post-bariatric surgery Short bowel syndrome Inflammatory bowel disease (UC and Chron’s) disease Pancreatitis Biliary tract diseases
602 - Breastfeeding complications 602a - Severe Engorgement 602b - Recurrent plugged 602c - Mastitis 602d - Flat or inverted nipples 602e - Cracked, bleeding or severely sore nipples 602g - Failure of milk to come in by 4 days postpartum 602h - Tandem nursing (breastfeeding two siblings who are not twins) Auto-assign 602f age≥40 years. Risk 602 1c. How long are you planning to breastfeed your infant? Listen, ask, and assess for Returning to work/school Pumping Storage Continuation of BF Anticipated or current separation from infant Text box Contents of text box go to S portion of care plan. Rapport 1d. Are you currently employed or attending school >10 hours/week? buttons: Yes No Reporting 1e. What type of support do you have for breastfeeding? Listen, ask, and assess for Partner/spouse Other family members Work/school environment Text box Contents of text box go to S portion of care plan. Rapport 1f. Do you need any help or assistance from the WIC program? Listen, ask, and assess for BF equipment need, current use, type, experience using BF PC CPA Lactation specialist Additional referral Text box (In screen design, this text box was combined with the one just previous.) Training – user would click on the BF equipment and go to the BF equipment if any is needed from WIC.
353 - Food allergies, please list: <Text box> 342 - Gastrointestinal disorder <Condition List Box> 349 - Genetic and congenital disorders <Condition List Box> 345 - Hypertension (includes chronic and pregnancy induced) 356 - Hypoglycemia 351 - Inborn error of metabolism <Condition List Box> 352 - Infectious disease, affects nutritional status <Condition List Box> 355 - Lactose intolerance, diagnosed 341 - Nutrient deficiency disease <Condition List Box> 359 - Recent major surgery (including C-sections), trauma, or burns severe enough to affect nutritional status <Text box> 901 - Recipient of in the past 6 months 346 - Renal disease <Condition List Box> 344 - Thyroid disorder Parkinson’s disease Multiple Sclerosis (MS) Eating disorders list box values: Self-induced vomiting Purgative abuse Use of drugs such as appetite suppressants, thyroid preparations or diuretics Alternating periods of starvation Self-induced marked weight loss Gastrointestinal disorder list box values: Gastroesophageal reflux disease (GERD) Peptic ulcer Post-bariatric surgery bowel syndrome Inflammatory bowel disease (UC and Chron’s) Liver disease Pancreatitis Biliary diseases
3e. Do you have any problems with food preparation and/or storage? Listen, ask, and assess for Refrigeration Cooking equipment Adequate food Family table Safe water Text box Contents of text box go to S portion of care plan. Referral Bottom Panel Participates in the following Nutrition Programs: _________, ________, ___________ Can I help you in any other way? Do you have enough food in the Listen for food security Community food pantry Commodity program SHARE Display any Nutrition Programs that were previously marked in Program Participation. Conversation starter, Food security, Referral
4h. Past Drug Use In the 3 months before you were pregnant, did you use street drugs? How about now? Listen for OTC drugs recognized as safe Prescription medications Illegal drugs 372b - Illegal drug use Risk 372 4i. What are your plans for returning to your shape? Listen, ask, and assess for physical activities walking playing with children safe parks access to fitness centers activity frequency food consumption changes Text box Contents of text box go to S portion of care plan. Rapport, referral Bottom What of activities do you and your family do together? Conversation starter