Add Patient

A. Date of Visit?

B. Age of patient in years?

C. Type of Visit? Choose one. [Well Child Check (WCC), Follow-Up Visit (FUV), New Patient Visit (NPV), Consult(CON)]

D. Sex of patient assigned at birth? [Male (M) or Female (F)]

E. Gender identity of patient? [Male (M), Female (F), Transmale (TM), Transfemale (TF), Non-binary (NB), Didn't ask (DA)]

F. Did you administer a standardized rating tool to assess ADHD symptoms to inform intital diagnosis? [Yes (Y) or No (N)]

G. Was a need identified by a screening tool (SC), parent concern (PC), teacher concern (TC), or child concern (CC)?

H. Which rating tool did you use? [Vanderbilt (Van), Other (O)]

I. If you chose Other, what is the name of the standardized rating tool used?

J. Who completed this rating tool? [Parent (P), Teacher (T), Both (B), Neither (N)]

K. How many of items 1-9 were positive on the Vanderbilt caregiver form? Please enter score from 0-9.

L. How many of items 10-18 were positive on the Vanderbilt caregiver form? Please enter score from 0-9.

M. How many of items 1-9 were positive on the Vanderbilt teacher form? Please enter score from 0-9.

N. How many of items 10-18 were positive on the Vanderbilt teacher form? Please enter score from 0-9.

O. Were the rating tool results documented in the medical record? [Yes (Y) or No (N)]

P. Do you have additional patients to enter? [Yes (Y) or No (N)]