Birth details - To be completed by health professional
  Name of child: ____________________________________
            Sex: __
            
  Neonatal Information
    Birth Weight (kg): ___________
    Birth Length (cm): ___________
    Vitamin K given  : __
             1st dose: ___________
             2nd dose: ___________
    Hep B given      : __
      Date given     : ___________
    Abnormalities noted at birth:
      _______________________________________________
<subjectType value="Patient"/> <item> <linkId value="birthDetails"/> <text value="Birth details - To be completed by health professional"/> <type value="group"/> <item> <type value="group"/> <item> <linkId value="nameOfChild"/> <text value="Name of child"/> <type value="string"/> </item> <item> <linkId value="sex"/> <text value="Sex"/> <type value="choice"/> <option> <valueCoding> <code value="F"/> </valueCoding> </option> <option> <valueCoding> <code value="M"/> </valueCoding> </option> </item> </item> <item> <linkId value="neonatalInformation"/> <text value="Neonatal Information"/> <type value="group"/> <item> <linkId value="birthWeight"/> <text value="Birth weight (kg)"/> <type value="decimal"/> </item> <item> <linkId value="birthLength"/> <text value="Birth length (cm)"/> <type value="decimal"/> </item> <item> <linkId value="vitaminKgiven"/> <text value="Vitamin K given"/> <type value="choice"/> <option> <valueCoding> <code value="INJECTION"/> </valueCoding> </option> <option> <valueCoding> <code value="INTRAVENOUS"/> </valueCoding> </option> <option> <valueCoding> <code value="ORAL"/> </valueCoding> </option> <item> <linkId value="vitaminKgivenDoses"/> <type value="group"/> <enableWhen> <question value="vitaminKgiven"/> <hasAnswer value="true"/> </enableWhen> <item> <linkId value="vitaminiKDose1"/> <text value="1st dose"/> <type value="dateTime"/> </item> <item> <linkId value="vitaminiKDose2"/> <text value="2nd dose"/> <type value="dateTime"/> </item> </item> </item> <item> <linkId value="hepBgiven"/> <text value="Hep B given y / n"/> <type value="boolean"/> <item> <linkId value="hepBgivenDate"/> <text value="Date given"/> <type value="date"/> </item> </item> <item> <linkId value="abnormalitiesAtBirth"/> <text value="Abnormalities noted at birth"/> <type value="string"/> </item> </item> </item> </Questionnaire>