Get Az 6-hrpp-004 2012-2025

Filling out the AZ 6-HRPP-004 form accurately is crucial for effective communication within the High-Risk Perinatal Program. This guide will provide you with a step-by-step approach to help you complete this online form with confidence.

Follow the steps to successfully complete the AZ 6-HRPP-004 form.

1. Press the ‘Get Form’ button to obtain the AZ 6-HRPP-004 form and open it in your preferred editor.
2. Begin by entering the current hospital's name in the designated field.
3. Fill in the infant’s first and last name, ensuring that the alias is also recorded if applicable.
4. Enter a contact phone number for any follow-up communication.
5. Specify the gestational age of the infant as assessed during the examination, indicated in weeks.
6. Document the discharge date, ensuring it reflects the correct date of leave from the hospital.
7. Indicate the respiratory treatments administered from the provided list, marking all that apply.
8. Record relevant cardiovascular diagnoses or complications, checking the appropriate boxes.
9. Detail any cardiovascular treatments that were provided, using the selection options available.
10. Fill out gastrointestinal/genitourinary issues as applicable, marking the appropriate codes.
11. Begin filling out the neurological diagnosis section, ensuring to check all relevant items.
12. Complete the birth details section, including length, weight, and Apgar scores at designated times.
13. Select the appropriate boxes for any additional complications and diagnoses noted.
14. Include discharge adaptations required for the infant such as an apnea monitor or specialized feeding.
15. Provide information on newborn screenings conducted, including hearing and bloodspot screens.
16. List any immunizations given during the hospital stay and mark any that are pending.
17. Indicate the discharge risk level and provide any additional criteria or comments related to the infant's condition.
18. Record any developmental assessments and referrals for additional support or services required.
19. Once all sections are completed and reviewed, finalize the form by saving changes. You may download, print, or share the form as needed.

Complete your AZ 6-HRPP-004 form online now and ensure a smooth transition for your infant.