RESIDENT ORIENTATION FOR PEDIATRIC CLINIC
Welcome to the Pediatric Clinic. We hope this will be an enjoyable and informative month for you. Please
read this information carefully. We welcome your suggestions.
1. Clinic Times:
AM Clinics – 8:30 AM to 12:00 PM (noon)
PM Clinics – 1:30 PM to 5:00 PM
Please arrive on time. Obviously, you need to stay until all of the patients have been seen and taken
care of.
2. Resident Responsibilities:
 The resident will evaluate clinic patients by taking a history, performing an examination, and
generating an assessment, differential diagnosis, and treatment plan.
 Please consult with the clinic attending frequently. Not only can we provide guidance with more
complex patients, we can also clarify and give advice on ambulatory pediatric issues such as
growth and development, anticipatory guidance, immunizations, etc. The faculty can provide help
in the area of non-organic issues: enuresis, encopresis, recurrent abdominal pain, school
avoidance, and many others as well as current thinking on anti-convulsant duration, surgical
repair, cleft lip, palate, umbilical hernias, undescended testicles, etc.
 Remember, it is unlikely that you will be the doctor who sees a patient at his/her next visit to
clinic. Your notes, particularly your assessment and plan, should be indicative of your thoughts.
For example, be very clear if an ENT referral is indicated if an ear infection persists. All
medications should include dosage, frequency, and duration. Please note the above in a free
form plan if it can not be conveyed through a preformed macro. Free form notes can also be
made in addition to a preformed macro plan if needed.
 If clinic is busy, try not to stop to complete EMR charts. Make brief notes and move on to
subsequent patients.
 Go over the yellow History Form on each new patient. It is designed to be filled in by the child’s
parent/guardian and then reviewed by you, filling in areas not completed and writing in additional
information on “yes” answers given by the parent. Then enter the information in the EMR past
medical, social, family history sections. After entering the information, place the original in the “to
be scanned” rack.
 When necessary, assist the nurses with any questions regarding telephone management of our
patients. Notify the attending of your recommendations.
 Occasionally, you may be asked by the attending to oversee the medical students as they see
patients. This is often helpful if we are extremely busy.
 For well-child visits, give parents the appropriate information sheet (birth to age 5 years available)
and discuss with them, time permitting. It is usually clipped to the front of the chart. Familiarize
yourself with these forms.
 Typically, residents will be asked to see rooms that have more than one patient, as this is often
somewhat overwhelming for medical students and interns.
 On days that you are on call, you are to leave clinic at 5:00 to assume call responsibilities. EMR
notes can be completed in the hospital if needed. Please notify the attendings the afternoons you
are on call and when you are leaving from clinic if clinic is not over by 5:00 on those afternoons.
You should be permitted to attend noon conference as well.
3. Other Duties:
 On mornings that you are scheduled to be in the Pediatric Clinic, you will need to be at the Clinic
by 8:30 AM.
 Each resident should learn about each of the following. You should actually perform and interpret
each at least once during the month.
1. Peak Expiratory Flow Rate
2. Tympanometry
3. Vision testing
4. Hearing testing (OAE, audiometry)
5. Injections
Clinic Resident Orientation
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6. O2 sat monitoring
7. Nebulizer treatment
8. MDI Instruction (asthma)
The clinic nurses and attendings will be happy to assist you.
While Specialty Clinics (Cardiology, High Risk, Sickle Cell) are going on, you are expected to
remain in the General Peds Clinic with the attending.
When there are two or more upper level residents assigned to the Pediatric Clinic, the resident
that is doing an elective month will attend the ADHD Clinic on Monday afternoons (1:30 to 5:00
PM) if he/she desires.
When doing an elective month, you are to have 2 half days a week for independent study. Please
make a schedule or write down the times you will not be in clinic.
4. The following will be explained during your orientation to clinic:
EMR ordering –(communication with the nurses, lab, and scheduling)
Patient flow
EMR Billing
5. An average of 4 morning conferences will be held to discuss a variety of clinical topics to be chosen
by you. I will set specific days at the beginning of the month.
6. There is a collection of resident articles that will be provided to you on cd. The collection is also
available on the share drive under “resident/student share” in the “pediatrics” folder. Please read the
articles designated “clinic resident’ by the end of the rotation.
We look forward to working with you!
Karen Burgess, M.D.
Asst. Prof. of Pediatrics
12/06/2005
Clinic Resident Orientation
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Clinic Reference:
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Put a sticky note on a patient’s chart to indicate that you are in the room with that patient
Scan the box at the bottom of the rooms view to see which patients are “PEDS” and which ones
are “SMITH”. Typically, see the PEDS patients unless we are slow and Beth is getting slammed,
then offer to see some of the patients waiting on her schedule
When you open the “ORDERING PROGRAM”, change the “on behalf of”, “attending”, and “suite”
to reflect the attending who is in clinic with you and that you are in Peds not Red or Blue. This
ensures that Peds attendings are notified of labs you order and that the nurses in Peds get your
orders instead of them going to a Family Medicine suite.
Bill shots, nebulizer treatments, pulse oximetry, peak flows, hearing and vision screens, ear wax
removal, etc., ANYTHING we do in clinic is to be billed.
Once ordered in the “ORDERING PROGRAM”, highlight the items to be billed and click the “Bill”
button FIRST, BEFORE you click the “Order” button.
Upon completing documentation, for sick visits click the “E&M Calculator” button and submit
calculated charge as is then save your note to the chart.
If patient is being seen for a check-up, only give the Dx of “Well Child” if there is NOTHING wrong
with the patient. If there is a URI or ANYTHING else, give that diagnosis instead. You can not
give a diagnosis of “Well Child” with any other diagnosis.
If a patient is returning for a recheck/follow-up from a previous visit, diagnose the child with “Other
Follow-Up Exam” instead of just “Otitis Media—resolving” for example. This signifies to Medicaid
that this patient visit was at the physician’s request and should not count toward number of
allowed annual visits.
For Medicaid check-ups, if you have given a diagnosis of “Well Child”, then choose “EPSDT
Normal” as the bill. If you have given ANY OTHER diagnosis, choose “EPSDT Abnormal”
For private insurance check-ups, if you have given a diagnosis of “Well Child”, then choose the
age-appropriate preventive medicine code. If you have given them ANY OTHER diagnosis, then
you use the E&M Calculator to generate the charge even though it was a check-up.
Submit bill under the attending’s name who is in clinic with you, not under your name with
someone else’s as is done in the Family Medicine suites. If there is more than one attending on a
given afternoon, alternate billing between attendings. If you confer with an attending regarding a
patient or if an attending sees a patient with you, submit bill under that attending’s name.
Do not sign your saved note. Once mark is made in the signing area, no attending changes can
be made.
Message the attending to whom billing credit was given to “Review & sign chart”.