Date of Visit :	{$ped_assessment.assessment_date}	Age:	{$age}
Complain & Present History :	{$ped_assessment.comp_present_history}
Cyanotic :	{$ped_assessment.cyanotic}	Chest infection :	{$ped_assessment.chest_infection}
Exercise tolerance :	{$ped_assessment.exercise_tolerance}	Chest pain :	{$ped_assessment.chest_pain}
Palpitations :	{$ped_assessment.palpitations}	Hospitalization :	{$ped_assessment.hospitalization}
Edema :	{$ped_assessment.edema}	Others:	{$ped_assessment.ped_comp_others}
Pregnancy History and Prenatal Testing:
Genetic syndromes:	{$ped_assessment.gen_syndromes}
Maternal illness:	{$ped_assessment.maternal_illness}
Family history:	Congenital cardiac diseases sudden death
Others:	{$ped_assessment.ped_others}
Past History:
Medical:	{$ped_assessment.medical}
Surgical:	{$ped_assessment.surgical}
Co-morbidities:	{$ped_assessment.ped_comorbidities}
Allergies:	{$ped_assessment.allergies}
Previous investigations:	{$ped_assessment.prev_invst}
General Examination:
General condition:	{$ped_assessment.gen_condition}	Mental status:	{$ped_assessment.mental_status}
Built:	{$ped_assessment.built}	Decubitus:	{$ped_assessment.decubitus}
Facies:	{$ped_assessment.facies}	Complexion:	{$ped_assessment.complexion}
Pulsation:	{$ped_assessment.pulsation}	Lymph nodes:	{$ped_assessment.lymph_nodes}
Upper limb:	{$ped_assessment.upper_limb}	Lower limb:	{$ped_assessment.lower_limb}

Cardiac Auscultation:	S1:	{$ped_assessment.card_s1}	S2:	{$ped_assessment.card_s2}	Murmurs:	{$ped_assessment.murmurs}
Chest Auscultation:	{$ped_assessment.chest_auscultation}

{if $ped_assessment.assessment_note} {/if}

ECG:	{$ped_assessment.ecg}	CXR:	{$ped_assessment.cxr}
Notes:	{$ped_assessment.assessment_note}

{if $medCount > 0}

Current Medication

{foreach $allMedData as $data } {/foreach}

Drug	Dosage frequency	Route	Duration
{$data.drugName}	{$data.drugdos}	{$data.route}	{$data.duration}

{/if}

Provisional Diagnosis:	{$ped_assessment.prov_diagnos}
Plan:	{$ped_assessment.plan}

Patient was educated about his/her diagnosis, Plan of Care and follow up

Referral

{$ref_dr}

Physician name

{$phys.name}

Physician Signature:

{if $carePlanCount > 0}

Physician care plan – خطة رعاية الطبيب

{foreach $allCarePlanData as $data } {/foreach}

Date	Needs	Intervention	Outcome	Timeframe	Dr Signature
{$data.care_plan_date}	{$data.needs}	{$data.intervention}	{$data.outcome}	{$data.timeframe}

{/if}