Your Primary Referral Source

1. Your Primary Referral Source

2. Our Mission is…. To engage and serve Michigan families through the promotion of chiropractic care and public education, as well as to establish meaningful communication with other healthcare professionals and organizations.

3. Our Focus is… To educate and to support a healthy, natural, well-based lifestyle.

4. We are pleased to present our Pediatric Forms. • The Benefits of using our forms: • Documentation • Easy to Understand and Complete • Mom and Dad Document More • More Information and Observation Provided • Increases Care Time with Patient • Less Note-taking • More Efficient Flow in Office • Exam • Logical Flow • Tailored for Each Age and Milestone • Every Step Documented • Conversation Builder in Chiropractic Lifestyle • Lifestyle Choices • (i.e. Is your vaccine history up-to-date, partial, delaying , conscientious objector or concern unknown?)

5. The forms are broken intothe following groups: • Infant (0-12 Months) • Questionnaire • Examination • 0-4 Months • 5-12 Months • Toddler (13-36 Months) • Questionnaire • Examination • Child (4-12 Years) • Questionnaire • Examination

6. The Infant Questionnaire (0-12 Months): • Lifestyle Information • i.e. How do you rate your awareness and effort to avoid environmental chemicals and toxins for your baby? • Subluxation Related Complaints • i.e. Ear Aches / Ear Infections • General Health • Pregnancy History • Birth & Labor History • Postnatal History • Family History • Infant Health History • Medical History

7. The Infant Evaluations: • 0-4 Months • Tone Movements • i.e. Ventral Suspension • Observation: Diagnosis : WNL / Hypotonia / Hypertonia • Palpation Findings • Neurological • i.e. Eye Tracking • Observation: WNL / Abnormal (Functional / Pathological) • Infantile Reflexes • i.e. Grasp • Observation: WNL / Dysfunctional / Findings • Physical Exam

8. The Infant Evaluations: • 5-12 Months • Palpation Findings • Neuro-Sensory • i.e. Crawling • Observations [ WNL (Integrated)/ Dysfunctional (Mild/Mod/Mark/ Path) Findings] • Physical Exam • Neurological

9. Toddler Questionnaire 13-36 Months: • Lifestyle Information • i.e. How do you rate your toddler’s diet and quality of food intake? • Subluxation • i.e. Back Arching/Tension • General Health • Pregnancy History • Shorter than Infant Questionnaire due to age of child entering Chiropractic Care • Birth/Labor History • Shorter than Infant Questionnaire due to age of child entering Chiropractic Care • Postnatal History • Family History

10. Toddler Examination 13-36 Months: • Development & Neurosensory • Broken into 3 Categories • a - accomplished • b - emerging • c - advanced • Major Milestone Development Ages • 13- 20 Months • 21-28 Months • 29-36 Months • i.e. (a) Can your toddler pick up a very small object with the tips of his fingers and thumb? (b) Does your toddler play by stacking small blocks upon one another? (c) Can your toddler turn the pages of a book all by herself?

11. Child Questionnaire 4-12 Years: • Lifestyle Information • i.e. How do you rate your child’s diet and quality of food intake? • Subluxation • i.e. Bedwetting/Enuresis • Pregnancy and Prenatal History • Combined due to age of child starting chiropractic care • Family History • Developmental & Neurosensory • Broken in two categories: Avoiding (a) and Seeking (s) • i.e. (a). Covers ears to avoid noise? • i.e. (s). Seems to ignore you often? • Infant Health History • i.e. Urinary – Foul-smelling Urine • Medical History

12. Child Examination 4-12 Years: • Orthopedic • Child-Size Diagram • Neuro-Sensory • i.e. Finger-to-Nose • WNL / Active / Dysfunctional / Findings • Neurological

13. Additional Resources for Your Practice

15. Thank you for your time. If you have any additional questions please contact us at 586.726.7333 or info@mcpakids.org. Together we can do great things!