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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AHLTA and other training resources

Additional TSWF support

Pediatrics Nursing Services Recent Changes

  • 7 changes for DEC-Aug 2018 update
  • Revision 1 – returned Patient Accompanied and Chaperone fields to the Screening tab
  • Added to ECG clinical clues of:”CPT: 93041: ECG Rhythm strip; Tracing Only w/o Interp & Report“.
  • Added to ECG clinical clues: “Use both CPT codes with rhythm strip. Only use CPT 93005 if performing an ECG without rhythm strip.”
  • Changed name of of IV Hydration ribbon to “IV Hydration/Lab Draw”.
  • Added a new free text field to the ribbon with prepositioned text for Lab Draw
  • Added clinical clues for coding blood draw documentation. “CPT: 36415: Only when completing Venipuncture w/o inserting an IV. Do not use if in conjunction with IV insertion.”
  • Added clinical clue CPT: 36416: Collection of capillary blood specimen
  • Added G6PD as an exclusion criteria to the Dysuria SSP

Sep – Dec Mid-Cycle Changes

  • Revision 1 – Returned Patient Accompanied and Chaperone fields to the Screening tab


  • 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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