ISR Daily BUDS Interview
For Stephanie Hogan ISR Columbus GA
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Child's Full Name *
Date *
BOWEL & URINE
Were all bowel movements since the last session normal in consistency and schedule? *
Was urine output more, normal, or less than usual in the hour after the last lesson? *
Has urination frequency/amount been normal since the last lesson? *
Explanation for any changes to bowel & urine
DIET
What has your child had to eat or drink in the last two hours? Please note when. *
Please list any new foods given since the last lesson, as well as any new reaction to the new food. *
SLEEP
Was your child's sleep/nap schedule typical since the last lesson? *
Did your child fall asleep within 10 minutes of the last lesson? *
Explanation for any changes to sleep
ACTIVITY
Have there been any changes to your child's activity/energy level or normal routine since the last lesson? *
Has your child been swimming in water (other than bathing) since the last lesson? *
Has your child had any illnesses, seizures, fever >100.5, vomiting, or skin rashes since the last lesson? *
Has your child had any injuries or required any medical attention (including MD appts)? *
Has your child taken any medication since the last lesson? *
Explanation for YES answers and list all medications:
Child's temperature within one hour of lesson and/or 24 hour activity notes (if required)
CONCERNS
Do you have any questions or concerns about your child participating in lessons today, or about your child's progression so far? *
I give consent for my child to enter the pool for lessons today. *
Please type Parent/Guardian Full Name.
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