Family Information Notebook (FIN) - Vanderbilt Kennedy Center
Family Information Notebook (FIN) - Vanderbilt Kennedy Center
Family Information Notebook (FIN) - Vanderbilt Kennedy Center
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CHILD’S NAME: DATE OF BIRTH:<br />
9<br />
BASELINE DATA<br />
NORMAL VITAL SIGNS:<br />
Pulse rate: _________________ Site best taken: _______________________________________<br />
Blood pressure: _____________ Site best taken: _______________________________________<br />
Temperature: _______________ Site best taken: _______________________________________<br />
Respiratory Rate: _________ per minute Skin color: ___________________________<br />
Oxygen Saturation: ________________________________<br />
Pupils (normal, dilated, constricted, equal): _____________________<br />
Blood draw site: ____________________________________________________________<br />
SYSTEMS (BASELINE DATA)<br />
CNS / Sensory<br />
Heart / Blood (Include recent<br />
blood counts)<br />
Gastrointestinal<br />
Respiratory (describe<br />
breathing sounds)<br />
Genitourinary<br />
Musculoskeletal<br />
Baseline X-ray findings<br />
Developmental<br />
Labs<br />
Prosthesis / Appliances/<br />
Technological Devices<br />
Others<br />
OKAY<br />
b<br />
PROBLEM<br />
b<br />
COMMENTS/DESCRIPTION<br />
© Junior League <strong>Family</strong> Resource <strong>Center</strong> 2005