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Add Patient
A. Date of Visit?
B. Age of patient in years?
Please enter age between 6 and 26
C. Type of Visit? Choose one. [Well Child Check (WCC), Follow-Up Visit (FUV), New Patient Visit (NPV), Consult (CON) ]
WCC
FUV
NPV
CON
D. Sex of patient assigned at birth? [Male (M) or Female (F)]
M
F
E. Gender identity of patient? Choose one. [Male (M), Female (F), Transmale (TM), Transfemale (TF), Non-binary (NB), Didn't ask (DA)]
M
F
TM
TF
NB
DA
F. Did you administer a standardized rating tool to monitor ADHD symptoms? [Yes (Y) or No (N)]
Y
N
G. Was a need identified by a screening tool (SC), parent concern (PC), teacher concern (TC), or child concern (CC)?
SC
PC
TC
CC
H. Which standardized rating tool did you use? [Vanderbilt (Van), Other (O)]
Van
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)]
P
T
B
N
K. How many of items 1-9 were positive on the Vanderbilt parent form? Please enter score from 0-9.
L. How many of items 10-18 were positive on the Vanderbilt parent form? Please enter score from 0-9.
M. Was there evidence of improvement from the previous rating scale? [Yes (Y, No (N), or Not Applicable (NA)]
Y
N
NA
N. Did you use the results to change treatment? [Yes (Y) or No (N)]
Y
N
O. How many of items 1-9 were positive on the Vanderbilt teacher form? Please enter score from 0-9.
P. How many of items 10-18 were positive on the Vanderbilt teacher form? Please enter score from 0-9.
Q. Was there evidence of improvement from the previous rating scale? [Yes (Y, No (N), or Not Applicable (NA)]
Y
N
NA
R. Did you use the results to change treatment? [Yes (Y) or No (N)]
Y
N
S. What was the score of the Other teacher form? Choose one. [Positive (P), Negative (N), Not Administered (NA)]
P
N
NA
T. Was there evidence of improvement from the previous rating scale? [Yes (Y), No (N), or Not Applicable (NA)]
Y
N
NA
U. Did you use the results to change treatment? [Yes (Y) or No (N)]
Y
N
V. Were the rating tool results documented in the medical record? [Yes (Y) or No (N)]
Y
N
W. Do you have additional patients to enter? [Yes (Y) or No (N)]
Y
N
Congratulations!
You have entered patient records. Please enter 20 records more to complete this dataset.
