Upon reflection,  I came up with a format  to collect data on dyads receiving
substandard care.  Some areas will not be applicable and may be completed by
placing an N/A or none next to it.  Please feel free to make suggestions for
additions or revision.  Chris Betzold NP IBCLC MSN  <A HREF="http://www.starfireinternational.net/breastfed">
http://www.starfireinternational.net/breastfed</A>


1. Mother's name and age
     Infant's name and age

2.  Pertinent mother's past medical history
     Pertinent Infant's past medical history

3.  Current Medications
      Mother
      Infant

4.  Contributing Labor information

5.  Initial Problem and Diagnosis (Include subjective, objective and
assessment data)
      mother
      infant

6.  Revised Diagnosis
     mother
     infant

7.  Initial Treatment rendered
     mother
     infant

8. Initial Treatment plan outcome
     mother
     infant

9. Revised Treatment Plan
     mother
    infant

10. References, Comments  and Rationale

11.  Any other pertinent information or follow up



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