The TSWF Pediatric Nursing Services AIM form is intended to be used by nurses and clinical support staff in PCMH clinics for pediatric patients. The form is not designed for use in adult and non-PCMH immunization clinics.

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Pediatrics Nursing Services Recent Changes
  • 1 changes for May-Aug 2019 update

Immunizations Tab

  • Added ‘Pre-Vaccination Screening Checklist’ ribbon

Jan-Apr Mid-Cycle Changes

  • Revision 1 -Split the Urinary Tract Infection / Dysuria box into two sections to allow more room for documenting.
  • Revision 2 – Changed Depo clue to read “DEPO Window= target 13 weeks (91 days) with range 11-15 weeks (77 days to 105 days)
  • Created December 2015
  • Standardize documentation
  • Intended use in PCMH clinics for pediatric patients
The TSWF Pediatric Nursing Services form was created in late 2015 and went live on the AHLTA Enterprise in September 2016. It was created to standardize the nursing services documentation of administered immunizations, medications, nursing procedures, and patient education/counseling performed at the point-of-service. The form’s intended use is acute, routine, or other scheduled visits to PCMH clinics for Pediatric patients 0 months to 17 years of age.
Form Lead
TSWF-Pediatrics Nursing Services Form Lead
Scot Ario

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