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Guidelines for Care and Care Plans

Care Plans

The Family and Physician Management Plan is one example of a Care Plan. It is constructed to invite information from families and also to remind families and physicians about the clinical issues to address for a given diagnosis. Software is being developed to improve the ease and efficiency of it’s use by families and by physicians. Management plans for children with developmental delay, cerebral palsy, cleft lip and palate, autism and seizures are available on our homepage.

Family and Physician Management Plan for Children with Developmental Delay
Information about Current Services.

Health care providers

Primary care
- Physician Name
- Practice Name
- Phone Number
- Email
Specialty care
- Physician Name:
- Practice Name
- Phone Number
- Email
Dentist
- Physician Name
- Practice Name
- Phone Number
- Email

Mental health services/providers

Physician Name
Practice Name
Phone Number
Email

Educational services

School name
Grade
Teacher
Support services (for example, physical therapy, resource room or aide)

Other community services/providers (for example, the speech pathologist and community health nurse)

Medications (If your child is taking several medications regularly, you may want to use the medication log)

Special diet/procedures (for example, gastrostomy feedings)

Equipment (for example, braces or wheelchair) Complementary/alternative treatments (for example, herbal and homeopathic treatments)

Allergies (please record medication, food and environmental allergies such as latex).

Immunizations

Emergency Care Management Form

Use the form developed by the American Academy of Pediatrics and the Association of Emergency Room Physicians. This form should be updated with each change in services and each time your child's care plan is updated.

Reports from Service Providers

Request copies of dictations from office visits with health care professionals; copies of your child’s IFSP, IEP or 504 plan; school progress reports and any testing done by educational staff. Make sure you keep your copies of reports in the Care Notebook so that this information is readily available to share when needed. Include reports from:

Medical specialists
Mental health providers
Educational staff, e.g., Early Intervention and Early Childhood Special Education providers
Other community providers

Results of Tests and Procedures

X-rays/procedures
Laboratory tests

Surgeries, Hospitalizations, Emergency Room Visits

Request copies of the dictations describing surgical procedures, hospital discharge summaries and emergency room chart notes for your care notebook. Please list the name of the surgical procedure, the primary reason for the hospitalization or the issue addressed at emergency room visits.

Surgical procedure
Over-night hospitalization
- Number of days and Issue addressed
Emergency room visit
- Issue addressed

Family Information

This information will enable your child’s health care provider to address the issues that you think are important for your child and for the family. It may include health issues as well as other issues such as your child’s participation in activities at school and in the community.

Your assessment of your child’s progress / accomplishments

In general, how is your child doing this year compared to last; a lot better, a little better, the same, a little worse or a lot worse?
If you rated your child a little or a lot worse, what are your specific concerns?
Did he or she achieve the goals that you identified at his last well child visit? Specific data forms may be helpful to you in monitoring your child's progress, for example, a daily behavioral, seizure or toileting log.
In general, how are you, your spouse and sibling doing?
Do you have questions about programs for siblings or need for financial assistance? The use of questionnaires such as the Family Needs Survey or Parenting Stress Index may assist you in reviewing your family’s support needs

Your goals for the next 6-12 months

Identify 1 or 2 specific, realistic goals that you would like your child or family to achieve; for example, walking without a walker, participating in field trips at school, and involving an older sister in a sibling program.

Your Questions

Identify 1 or 2 questions that are your highest priority to have answered at this visit.
Review the Guidelines of Care and the Management Plan for your child’s specific condition. The Guidelines of Care provide a brief review of clinical issues at each age, diagnostic tests as well as potential treatments and referrals. Each issue listed on the Management Plan is accompanied by a paragraph describing usual signs and symptoms as well as useful evaluations and treatments. Read each one to help you decide what issues to discuss with your child’s health care provider.

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