[+/-] Admission Details [0..*]
Admission Details Paediatric [0..1]
Name of Relation [0..1]
Sex [0..1] Male Female Not known Not specified
Relationship to subject [0..1]
[+/-] Communications about subject [0..1]
Contact verbally [0..*] Yes No
Include in correspondence [0..*] Yes No
Additional Family Information [0..*]
People Present at Assessment [0..1]
Reason for Admission [0..1]
Previous Experience of Hospitals [0..*]
Child's Understanding of Admission [0..*]
Parents' Understanding of Admission [0..*]
Parents' or Child's Concerns Regarding Admission [0..*]
Parent Resident [0..*]
Pets [0..*]
Parents or Child Want to be Active in Care [0..*]
Special Cultural and Spiritual Requirements [0..1]
Request for chaplaincy services [0..*] Yes No Not applicable
[+/-] Contacts with Other Services [0..*]
Contacts with Other Services Paediatric [0..1]
[+/-] Other Involved Professional [0..*]
Name [0..1]
School Attendance [0..1] Not Applicable Regular School Attender Irregular School Attender Excluded from School Temporarily Excluded from School Permanently Unknown
Other Early Years or Education or Training Provider [0..1]
Current Common Assessment Framework [0..*] Unknown Yes No
Needs Identified from Common Assessment Framework [0..*] Yes No
Previous Common Assessment Framework [0..*] Unknown Yes No
[+/-] If Child Protection concerns, refer to local policies and procedures [0..*]
Action Taken Relating to Child Protection Concerns [0..*]
[+/-] Communication [0..*]
Sight Problems [0..*] Yes No
[+/-] row [0..1]
row_head [0..1] Left Right Both eyes
Visual acuity [1] [5] - 5/6 [6] - 6/6 [7] - 6/7.5 [9] - 6/9 [12] - 6/12 [18] - 6/18 [36] - 6/36 [60] - 6/60 [100] - Count fingers [200] - Perceive light [300] - Blind
Visual aids [0..*] Pinhole Not known Spectacles Contact lenses None
Hearing Impairment [0..*] Unknown Yes No
Hearing Aid [0..1] None Left Right Bilateral
Known Speech and Language Difficulties [0..1]
Special Words or Signs [0..1]
Recent Changes to Speech and Language [0..1]
Child's Word for Pain [0..*]
Ways of Expressing Pain [0..*]
Additional Communication Information [0..*]
[+/-] Vital signs [0..*]
[+/-] PEWS [0..*]
[+/-] Safety [0..*]
Level of Supervision Required [0..1]
Previous Convulsions or Seizures [0..*] None Epileptic Seizures Febrile Convulsions Non-Febrile Convulsions
Temperature Control Measures Taken [0..*] None Light Clothing Air Cooling via Fan Ibuprofen Paracetamol
Recent Changes to Safety Considerations [0..*]
Additional Patient Safety Information [0..*]
[+/-] Breathing [0..*]
Usual Breathing Complaints [0..1] Gasping Grunting Kussmaul Snoring Inspiratory stridor Paradoxical breathing Recessing Nasal flare Apnoea Breathlessness Cough Excessive Secretions Wheeze None
Respiratory Support Home [0..1] None Artificial Airway Chest Physiotherapy Oxygen Therapy Suction Ventilation
[+/-] Home Ventilation includes CPAP [0..1]
Passive Exposure to Tobacco Smoke [0..*] Yes No
Recent Changes to Breathing [1]
Additional Breathing Information [0..1]
Timing [0..1] Day Time Night Time
[+/-] Recent Changes to Oxygen Usage? [0..1]
[+/-] Usual/Current Usage [0..2]
Usual/Current Usage [0..1] Usual Current
Oxygen Usage [0..1] Continuous Intermittent As Required
Oxygen Delivery Device [0..1] Face Mask Nasal Cannula Nasal Mask Simple Mask Venturi Mask BiPAP (Bilevel Continuous Positive Airway Pressure) CPAP (Continuous Positive Airway Pressure) Ventilator
Oxygen Flow Rate [0..1] ml/h ml/m ml/s
Oxygen Humidification [0..1] None Cold Warm
Additional Oxygen Information [0..1]
Ventilation Mode [0..1] BiPAP (Bilevel Continuous Positive Airway Pressure) CPAP (Continuous Positive Airway Pressure) Full Ventilation
Ventilator Machine Model [0..1]
Ventilation Inspiratory Pressure [0..1]
Ventilation Inspiratory Time [0..1]
Ventilation Expiratory Pressure [0..1]
Ventilation Respiratory Rate Total [0..1]
Ventilation Frequency Set [0..1]
Ventilation FiO2 [0..1]
Additional Ventilation Information [0..1]
[+/-] Nutrition [0..*]
Nutrition Type [0..1] Milk Diet Solids Diet Nutritional Supplement Total Parenteral Nutrition
Milk Diet Type [0..1] Breast Fed Formula milk Mixed Expressed Breast Milk Cow's Milk Lactose Free Milk
[+/-] Milk Diet [0..1]
Type of feeding [0..1] Bottle Beaker Cup Enteral tube
Usual Teat Type [0..1]
Milk Formula Name [0..1]
Temperature of Feed [0..1] Room Temperature Warm Cold
Additional Milk Diet Information [0..1]
[+/-] Solids Diet [0..1]
Usual Solids Diet Type [0..1] Normal Diet Toddler Diet Infant Appropriate Solids Weaning Solids
Preferred Foods [0..1]
Disliked Foods [0..1]
Required Food Consistency [0..1] Normal Consistency Lumpy Purée
Feeding Help Required [0..1] Fed by Adult Feeds Self Needs Some Help
Eating Utensils [0..1] Fork Knife and Fork Spoon Uses Fingers
Additional Solids Diet Information [0..1]
[+/-] Usual Drinks Other Than Milk [0..1]
Preferred Drinks [0..1]
Disliked Drinks [0..1]
Drinks from [0..1] Beaker Bottle Cup
Additional Other Drinks Information [0..1]
[+/-] Additional Nutrition Information [0..1]
Usual Feeding Complaints [0..1] Reflux Vomiting
Religious, Cultural or Lifestyle Dietary Preferences [0..1]
Special Feeding Aids [0..1]
Recent Changes to Nutrition [0..1]
Additional Nutrition Information [0..1]
[+/-] Usual Feed Times and Volumes [0..1]
[+/-] Feed Times and Volumes within Last 24 Hours [0..1]
Current Weight [0..1] gm kg
[+/-] Home Enteral Tube [0..*]
Enteral Tube Site [0..1] Nasogastric Nasojejunal Orogastric Jejunostomy Gastrostomy
External Length of Home Enteral Tube or Tube Marking [0..1]
Enteral Tube Location [0..1] Nostril, Left Nostril, Right Mouth Abdominal Wall
Enteral Tube Size [0..1]
Enteral Tube Pump Type [0..1]
Date Current Enteral Tube Inserted [0..1]
Additional Enteral Tube Feeding Information [0..1]
[+/-] Elimination [0..*]
Usual Elimination Complaints [0..1] Constipation Diarrhoea Soiling Urinary Problems None
Last Passed Urine [0..1]
Last Bowel Action [0..1]
Wears Nappies [0..1] Never Day Night Always
Nappy Type or Size [0..1]
Number of Dirty Nappies per Day [0..1]
Toilet Trained Urine [0..1] Never Day Night Always
Toilet Trained Bowel [0..1] Never Day Night Always
Usual Continence Aids [0..1]
Special Words or Signs for Elimination [0..1]
Recent Changes to Elimination [0..1]
Additional Elimination Information [0..1]
[+/-] Mobility [0..*]
Child's Usual Mobility [0..1]
Usual Mobility Aids [0..1] Walking Frame Wheelchair Crutches Two walking sticks Pushchair Rollator Tripod Electric Wheelchair Powered Scooter None
Recent Changes to Mobility [0..1]
Additional Mobility Information [0..1]
[+/-] Hygiene and Dressing [0..*]
Usual Hygiene and Dressing Routine [0..1]
Skin Care Products Used [1]
Recent Changes to Hygiene and Dressing Routine [0..1]
[+/-] Sleep [0..*]
Sleeps in [0..1] Bed Cot Basinette
Cot Sides Required [0..*] Yes No
Any Favourite Toys or Comforters [0..1]
Usual Sleeping Routine [0..1]
Recent Changes to Sleeping Routine [0..1]
Additional Sleeping Information [0..1]
[+/-] Playing and Learning [0..*]
Favourite Toys [0..1]
Favourite Activities or Hobbies [0..*]
Recent Changes to Playing and Learning [0..*]
Additional Playing and Learning Information [0..*]
[+/-] Sexual Development [0..*]
[+/-] data [1]
[+/-] Any event [0..1]
[+/-] data [1]
Text [0..1]
Additional Sexual Development Information [0..*]
[+/-] Normal Statements [0..1]
Normal Statement [0..*]
[+/-] Started menstruation [0..1]
Has the child started menstruation [0..*] Yes No
[+/-] Findings [0..1]
[+/-] Issues with periods [0..1]
Menstrual Cycle [0..1] Regular Irregular
Date of Last Menstrual Period [0..1]
[+/-] Cycle [0..1]
[+/-] Menstruation [0..1]
[+/-] Menstrual flow [0..1]
Clinical Description [0..1]
Relative Description [0..1] Very heavy flow Heavy flow Normal flow Light flow Spotting Absent
[+/-] Presence of blood clots [0..1]
[+/-] Flooding [0..1]
Menstrual Hygiene Dependency [0..1] Independent Requires Assistance Dependent
[+/-] Sanitary products used (to assess flow) [0..*]
Additional Menstruation Information [0..1]
[+/-] Menopausal [0..1]
[+/-] Substance Use [0..*]
[+/-] Facilities Checklist [0..*]
Parent / Child Orientated Ward and Parents' Accommodation [0..*] Yes No Not applicable
Parent / Carer Given an Access Pass [0..*] Yes No Not applicable
Parent Given Car Parking Permits and Parking Explained [0..*] Yes No Not applicable
Printed Information Given to Parents and Questions Answered [0..*] Yes No
Housekeeping Rules Discussed with Parents [0..*] Yes No
Visiting Rules Explained [0..*] Yes No
Infection Control Procedures Discussed with Parent / Carer [0..*] Yes No
Additional Facilities Information [0..*]
[+/-] Problems and Diagnoses [0..*]
[+/-] Allergies [0..*]
Adverse reaction description [0..1]
To record Assessment details on Paediatric Admission 
Encounter
