Reason for Referral: [Hyperbilirubinemia]

Referring Physician: [Look in the orders section or front page]

PATIENT'S HISTORY:

This baby was born on [Date of Birth] at [Time of Birth] to a [ X-year-old GXPX woman at X weeks] of gestational age via [SVD/AVD/C-Section etc ].

Maternal GBS was [negative] and serology was [protective].

Birthweight was [XYZ]g and Apgars were [X/9 or 10 ] at 1 minute and 5 minutes respectively.

Mother's blood type was [ ABO Pos Or Neg] and baby's blood type is [ABO PosOrNeg ].

Baby was discharged on [DATE] with follow-up in outpatient bilirubin clinic.

The baby's discharge weight was [XYZ]g.  The bilirubin level on [DATE] was [XYZ], which is [] risk zone.

TODAY'S VISIT:

Today at the bilirubin clinic, the patient's bilirubin level is [ ] at [ ] hours, which is in the [ ] risk zone.

The patient's current weight today is [ ] which is a [ ] from birthweight.

The baby is feeding [well] with [amount+frequency of feed] and is voiding and stooling [well] .

PHYSICAL EXAM:

The baby appeared well, pink, and active on exam.  Fontanelles were open, soft, and flat.  Palate was intact.  Tone and reflexes were all normal.  Heart sounds were normal with no murmurs, lung sounds were clear to auscultation, abdomen was soft, nontender, nondistended with good bowel sounds.  Genitalia was []. Anus was patent. Hip examination was normal, skin was normal.  The baby looks well-hydrated and healthy.

ASSESSMENT AND PLAN:

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Thank you for involving us in the care of this patient.