TRAIN Collaborative Data Collection TRAIN Collaborative - Data Collection Practice Name * Akron Children's Hospital, Clinic Independence Family Health Center, CCF Lima Pediatrics, Lima MetroHealth Medical Center, Foster Care Team Muskingum Valley Health Center, Zanesville The Pediatric Group, Piqua Pediatricenter, Mayfield Heights Other Practice Name Provider Name: * Date of Visit (MM/DD/YY): Patient Date of Birth (MM/DD/YY): * Patient Gender: Male Female Unknown Patient Ethnicity and/or Race: Hispanic/Latino American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White or Caucasian Two or More Races Unknown or Prefer Not to Answer Patient Insurance Type: Public/Medicaid Private Combination of Public/Private No Insurance Unknown or Prefer Not to Answer Is there documentation in the chart of the presence or absence of trauma for the anatomic regions below: * Ears Intra-oral Face Neck Genital Buttocks Torso Skin No documentation of any component Please provide any comments for this chart relating to completion of the physical examination. Was an injury identified at this visit? * Yes No What injuries were identified for this patient? (Select all that apply) * Subconjunctival hemorrhage Bruising/ecchymosis Open wounds Oropharyngeal injury Superficial injury (cuts, scrapes, lacerations) Genital injury Fractures Intracranial hemorrhage Abdominal trauma Intracranial injury Burns OtherOther What ICD-10 Code was used to document the injury? (Enter "none" or "unknown" if not documented.) * Was discussion of the following components of a psychosocial assessment documented? * Substance abuse by a caregiver Intimate partner violence between one or more caregivers Mental health illness of a caregiver Past law enforcement involvement of a caregiver Past children services involvement of a caregiver None documented If discussed, was a positive discovery of any of the following components of a psychosocial assessment documented? Substance abuse by a caregiver Intimate partner violence between one or more caregivers Mental health illness of a caregiver Past law enforcement involvement of a caregiver Past children services involvement of a caregiver Was a consultative call placed to a child abuse pediatrician to discuss further workup? * Yes No Did management of case change based on call? Did decision to report change based on call? Was a skeletal survey ordered for this infant? * Yes, ordered from the primary care office Yes, through referral to a Child Advocacy Center or other treatment center No Did management of case change based on results? Did decision to report change based on results? If known, please discuss why any part of the process was not completed or documented (psychosocial assessment, consultative call, or skeletal survey). Please share any additional comments or lessons learned during this case. Please share any additional comments or lessons learned during this case. Submit If you are human, leave this field blank.
