Table 1.

Selected obesity-related elements included in the well-child visit note template

Age Appropriate Health Topics
Nutrition
Drinks _ % Milk
Drinks 2-3 glasses of milk/day? _
Drinks>1 glass of juice or soda/day? _
Eating fruits and vegetables? _
Physical activity
Exercise outside of school? _
Sleep
Regular bedtime? _
TV in bedroom? _
Elimination
Caregiver concerns: _
Fully toilet trained? _
Enuresis or encopresis? _
Physical Examination
Height, weight, BMI (%’ile)1
Impression And Plan
Routine Health Maintenance
Growth_
Healthy nutrition and activity counseling?_
Active Problems
Childhood Obesity (BMI 95-100 percentile)2

¹Imports automatically into the note

²If previously added to the patient’s problem list, will import automatically into the note