Medical report to parents (abdominal pain or symptoms) Date: Student’s Name: Your child was seen in the Wellness Center today by



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Date07.02.2017
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MEDICAL REPORT TO PARENTS (ABDOMINAL PAIN OR SYMPTOMS)

Date:__________Student’s Name:________________________________________________
Your child was seen in the Wellness Center today by:


Your child complained of abdominal pain or abdominal-related symptoms.

  • Specific information:


We suggest the following:


  • Your child was seen by the Wellness Center nurse. If his/her condition persists, please schedule an appointment with the Nurse Practitioner at the Wellness Center or with your child’s regular provider.




  • Your child is complaining of a chronic condition and reports (s)he has already been evaluated by another provider. We suggest you follow-up with that provider.







  • Based on an exam and limited available testing, the Nurse Practitioner did not find signs of an acute surgical abdomen at this time. It is difficult to do a complete abdominal work up at the Wellness Center. Therefore, we suggest your child schedule an appointment with his/her regular provider if this continues. If your child does not have a regular provider, please contact us to discuss bringing your child for an appointment at the Wellness Center and taking your child for additional lab tests that we may want to order.




  • We were unable to reach you by phone today to pick up your child. We are concerned about your child’s pain and suggest that you seek the first available appointment with your regular provider or seek emergency care if necessary to obtain further work-up.




  • Seek immediate emergency care if your child develops “warning symptoms” of an acute abdomen. This includes high fever, severe vomiting to the point of not tolerating fluids, blood in vomit or stools, or severe abdominal pain.

Please feel free to contact us if you have additional questions about your child’s care.



WV School-Health Technical Assistance & Evaluation Center, Marshall University

SAMPLE FORM 2/7/2017






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