# NP Student Resources # CPT QuickCode Companion ### Procedures
Procedures - **69210** - Cerumen Impaction (per ear) - **17250** - Cauterize Umbilical Granuloma - **69090** - Ear Piercing (per ear) - **51701** - In and Out Cath - **17110** - Wart / Molluscum Destruction (<14 lesions) - **17111** – Wart / Molluscum Destruction (14+ lesions) - **99213** - Sports Physical (in our system you see a 99999 and the word SPORT, it makes it a $20 visit) - **99999** - Procedure only visit (use this in addition to Procedure CPT)
--- ### Clinic Administered Medications
Medications **Nebulizer Treatments** - **94640** - bill this for supplies plus med below - **J7613** - Albuterol - **J7614** - Xopenex - **J7620** - DuoNeb **Oral** - **Q0163** - Benadryl - **J2405** - Zofran ODT - **A9270** - Motrin - **A9270** - Tylenol **Injections** - **96372** - Injection Fee plus med below - **J0561** - Bicillin - **J0171** - Epinephrine (Epi-Pen) - **J0696** - Rocephin - **J8540** - Decadron
--- ### POC Testing
POC Testing - **87804** - Flu A/B - **87426** - COVID 19 - **87807** - RSV - **87880** - Strep A (Rapid) - **81002** - UA - **81025** - Urine Pregnancy Test
--- ### Vaccines
Vaccines **Vaccines** - **90697** - DTaP-IPV/HepB/Hib (Vaxelis) - **90671** - PCV15 Pneumococcal (Vaxneuvance) - **90680** - Rotavirus (Rotateq) - 3-dose - **90686** - Quad Flu, IM (Fluzone) - **90707** - MMR (M-M-R®II) - **90716** - Varicella (Varivax) - **90633** - HepA (Vaqta) - 2 dose - **90698** - DTaP-IPV/Hib (Pentacel) - **90710** - MMRV (Proquad) - **90696** - DTaP-IPV (Quadracel) - **90619** - Meningococcal Conj ACWY (Menquadfi) - **90715** - Tdap (Adacel) - **90651** - HPV (Gardasil) - **90621** - MenB-FHbp Meningococcal (Trumenba) - **90732** - PPSV23 Pneumococcal (Pneumovax 23) - **Used if off schedule:** - **90713** - IPV (Polio) - **90670** - PCV13 Pneumococcal (Prevnar 13) - **90744** - HepB (3-dose) - **90647** - Hib (PRP-OMP) (3-dose schedule) **Vaccine Administration Codes** - **< 18 years** - 90460 - vaccine admin, first component - 90461 - vaccine admin, each add’l component - **18 + Years** - 90471 - vaccine admin, combo - 90472 - vaccine admin, each add’l combo vaccine - 90473 - vaccine admin, intranasal/oral - 90474 - vaccine admin, each add’l intranasal/oral
--- ### Screening
Screening - **96127** - Anxiety (GAD / SCARED) / Depression (PHQ) - **96110** - Developmental Screen (SWYC / ASQ / MCHAT) - **96127** - ADHD Forms (Vanderbilt) - per form - **92551** - Hearing Eval (Pure Tone Audiometry) - **99173** - Vision Eval (Snellen Chart) - **99177** - SPOT Vision Screener
--- ### Problem Visit Billing
Problem Visit **New Patient** - 99203 - Detail Low Complexity (20 min) - 99204 - Moderate Complexity (30 min) - 99205 - High Complexity (40 min) **Established Patient** - 99213 - Expanded Low Complexity (20 min) - 99214 - Moderate Complexity (30 min) - 99215 - High Complexity (40 min)
--- ### Well Visits #### Pediatric
Newborn Visit **Well Check** - **Z00.110** - Health supervision for < 8 days old - **Z00.111** - Health supervision for 8-28 day old - **Z00.121** - Routine child exam w/ abnl - **CPT** - **99381** - New Pt Preventive < 1 yr - **99391** - Est Pt Preventive < 1 yr **Vaccines** - **Z29.11** - prophylactic immunotherapy for respiratory syncytial virus (RSV) - **CPT** - **90460** - Vaccine Admin - **90380** - Beyfortus (<5 kg) - **90381** - Beyfortus (5+ kg)
1 Month Visit **Well Check** - **Z00.111** - Health supervision for 8-28 day old - **Z00.129** - Routine child exam - **Z00.121** - Routine child exam w/ abnl - **CPT** - **99381** - New Pt Preventive < 1 yr - **99391** - Est Pt Preventive < 1 **Vaccines** - **Z29.11** - prophylactic immunotherapy for respiratory syncytial virus (RSV) - **CPT** - **90460** - Vaccine Admin - **90380** - Beyfortus (<5 kg) - **90381** - Beyfortus (5+ kg)
2 Month Visit **Well Check** - **Z00.129** - Routine child exam - **Z00.121** - Routine child exam w/ abnl - **CPT** - **99381** - New Pt Preventive < 1 yr - **99391** - Est Pt Preventive < 1 yr **Vaccines** - ****Z23 -**** Encounter for Vaccines - **CPT** - **90460** - (x3) Vaccine Admin - **90461** - (x3) Vaccine Admin, add’l component - **90697** - DTaP-IPV/HepB/Hib (Vaxelis) - **90671** - PCV15 Pneumococcal (Vaxneuvance) - **90680** - Rotavirus (Rotateq) - **Z29.11** - prophylactic immunotherapy for respiratory syncytial virus (RSV) - **CPT** - **90460** - Vaccine Admin - **90380** - Beyfortus (<5 kg) - **90381** - Beyfortus (5+ kg)
4 Month Visit **Well Check** - **Z00.129** - Routine child exam - **Z00.121** - Routine child exam w/ abnl - **CPT** - **99381** - New Pt Preventive < 1 yr - **99391** - Est Pt Preventive < 1 yr **Vaccines** - ****Z23 -**** Encounter for Vaccines - **CPT** - **90460** - (x3) Vaccine Admin - **90461** - (x3) Vaccine Admin, add’l component - **90697** - DTaP-IPV/HepB/Hib (Vaxelis) - **90671** - PCV15 Pneumococcal (Vaxneuvance) - **90680** - Rotavirus (Rotateq) - **Z29.11** - prophylactic immunotherapy for respiratory syncytial virus (RSV) - **CPT** - **90460** - Vaccine Admin - **90380** - Beyfortus (<5 kg) - **90381** - Beyfortus (5+ kg)
6 Month Visit **Well Check** - **Z00.129** - Routine child exam - **Z00.121** - Routine child exam w/ abnl - **CPT** - **99381** - New Pt Preventive < 1 yr - **99391** - Est Pt Preventive < 1 yr **Vaccines** - ****Z23 -**** Encounter for Vaccines - **CPT** - **90460** - (x3) Vaccine Admin - **90461** - (x3) Vaccine Admin, add’l component - **90697** - DTaP-IPV/HepB/Hib (Vaxelis) - **90671** - PCV15 Pneumococcal (Vaxneuvance) - **90680** - Rotavirus (Rotateq) - **Flu Vaccine** - **90460** - Vaccine Admin + (1 below) - **90686** - Quad Flu, IM - **90658** - Tri Flu, IM - **Z29.11** - prophylactic immunotherapy for respiratory syncytial virus (RSV) - **CPT** - **90460** - Vaccine Admin - **90380** - Beyfortus (<5 kg) - **90381** - Beyfortus (5+ kg)
9 Month Visit **Well Check** - **Z00.129** - Routine child exam - **Z00.121** - Routine child exam w/ abnl - **CPT** - **99381** - New Pt Preventive < 1 yr - **99391** - Est Pt Preventive < 1 yr **Developmental Screening** - **Z13.42** - Encounter for Dev Screening - **CPT** - **96110** - Dev Screen (SWYC or ASQ) **Vaccines** - ****Z23 -**** Encounter for Vaccines - **Flu Vaccine CPT** - **90460** - Vaccine Admin + (1 below) - **90686** - Quad Flu, IM - **90658** - Tri Flu, IM
12 Month Visit **Well Check** - **Z00.129** - Routine child exam - **Z00.121** - Routine child exam w/ abnl - **CPT** - **99381** - New Pt Preventive < 1 yr - **99391** - Est Pt Preventive < 1 yr **Vaccines** - ****Z23 -**** Encounter for Vaccines - **CPT** - **90460** - (x3) Vaccine Admin - **90461** - (x2) Vaccine Admin, add’l component - **90707** - MMR (M-M-R®II) - **90716** - Varicella (Varivax) - **90633** - HepA (Vaqta) - **Flu Vaccine CPT** - **90460** - Vaccine Admin + (1 below) - **90686** - Quad Flu, IM - **90658** - Tri Flu, IM **Labs (Labcorp)** - **Z13.88** - Screening for heavy metal poisoning - Labcorp Lead Order - **Z13.0** - Screening for Anemia - Labcorp Hgb Order
15 Month Visit **Well Check** - **Z00.129** - Routine child exam - **Z00.121** - Routine child exam w/ abnl - **CPT** - **99381** - New Pt Preventive < 1 yr - **99391** - Est Pt Preventive < 1 yr **Vaccines** - ****Z23 -**** Encounter for Vaccines - **CPT** - **90460** - (x2) Vaccine Admin - **90461** - (x2) Vaccine Admin, add’l component - **90671** - PCV15 Pneumococcal (Vaxneuvance) - **90698** - DTaP-IPV/Hib (Pentacel) - **Flu Vaccine CPT** - **90460** - Vaccine Admin + (1 below) - **90686** - Quad Flu, IM - **90658** - Tri Flu, IM
18 Month Visit **Well Check** - **Z00.129** - Routine child exam - **Z00.121** - Routine child exam w/ abnl - **CPT** - **99382** - New Pt Preventive 1-4 yrs - **99392** - Est Pt Preventive 1-4 yrs **Vaccines** - ****Z23 -**** Encounter for Vaccines - **CPT** - **90460** - Vaccine Admin - **90633** - HepA (Vaqta) - **Flu Vaccine CPT** - **90460** - Vaccine Admin + (1 below) - **90686** - Quad Flu, IM - **90658** - Tri Flu, IM **Developmental Screening** - **Z13.41** - Encounter for Autism Screening (MCHAT) - **Z13.42** - Encounter for Dev Screening - **CPT** - **96110** - (x2) Dev Screen (M-CHAT)
24 Month Visit **Well Check** - **Z00.129** - Routine child exam - **Z00.121** - Routine child exam w/ abnl - **CPT** - **99382** - New Pt Preventive 1-4 yrs - **99392** - Est Pt Preventive 1-4 yrs **Vaccines** - ****Z23 -**** Encounter for Vaccines - **Flu Vaccine CPT** - **90460** - Vaccine Admin + (1 below) - **90686** - Quad Flu, IM - **90658** - Tri Flu, IM - **90660** - FluMist, Nasal (2+ y/o) **Developmental Screening** - **Z13.41** - Encounter for Autism Screening (MCHAT) - **CPT** - **96110** - Dev Screen (M-CHAT) **Labs (Labcorp)** - **Z13.88** - Screening for heavy metal poisoning - Labcorp Lead Order - **Z13.0** - Screening for Anemia - Labcorp Hgb Order
30 Month Visit **Well Check** - **Z00.129** - Routine child exam - **Z00.121** - Routine child exam w/ abnl - **CPT** - **99382** - New Pt Preventive 1-4 yrs - **99392** - Est Pt Preventive 1-4 yrs **Vaccines** - ****Z23 -**** Encounter for Vaccines - **Flu Vaccine CPT** - **90460** - Vaccine Admin + (1 below) - **90686** - Quad Flu, IM - **90658** - Tri Flu, IM - **90660** - FluMist, Nasal **Developmental Screening** - **Z13.42** - Encounter for Dev Screening - **CPT** - **96110** - Dev Screen (SWYC or ASQ)
3 Year Visit **Well Check** - **Z00.129** - Routine child exam - **Z00.121** - Routine child exam w/ abnl - **CPT** - **99382** - New Pt Preventive 1-4 yrs - **99392** - Est Pt Preventive 1-4 yrs **Vaccines** - ****Z23 -**** Encounter for Vaccines - **Flu Vaccine CPT** - **90460** - Vaccine Admin + (1 below) - **90686** - Quad Flu, IM - **90658** - Tri Flu, IM - **90660** - FluMist, Nasal **Vision** - **Z01.00** - Enc for Vision Screen- Pass - **Z01.01** - Failed Vision Screen - **CPT** - **99173** - Vision Eval (Snellen Chart) - **99177** - SPOT Vision Screener
4 Year Visit **Well Child Exam** - **Z00.129** - Routine child exam - **Z00.121** - Routine child exam w/ abnl - **CPT** - **99382** - New Pt Preventive 1-4 yrs - **99392** - Est Pt Preventive 1-4 yrs **Vaccines** - ****Z23 -**** Encounter for Vaccines - **CPT** - **90460** - (x2) Vaccine Admin - **90461** - (x6) Vaccine Admin, add’l component - **90710** - MMRV (Proquad) - **90696** - DTaP-IPV (Quadracel) - **Flu Vaccine CPT** - **90460** - Vaccine Admin + (1 below) - **90686** - Quad Flu, IM - **90658** - Tri Flu, IM - **90660** - FluMist, Nasal **Hearing** - **Z01.10** - Enc for Hearing Screen - Pass - **Z01.118** - Failed Hearing Screen - **CPT** - **92551** - Hearing Eval (Pure Tone Audiometry) **Vision** - **Z01.00** - Enc for Vision Screen- Pass - **Z01.01** - Failed Vision Screen - **CPT** (only charge 1 depending on test performed) - **99173** - Vision Eval (Snellen Chart) - **99177** - SPOT Vision Screener
5 Year Visit **Well Child Exam** - **Z00.129** - Routine child exam - **Z00.121** - Routine child exam w/ abnl - **CPT** - **99383** - New Pt Preventive 5-11 yrs - **99393** - Est Pt Preventive 5-11 yrs **Vaccines** - ****Z23 -**** Encounter for Vaccines - **Flu Vaccine CPT** - **90460** - Vaccine Admin + (1 below) - **90686** - Quad Flu, IM - **90658** - Tri Flu, IM - **90660** - FluMist, Nasal **Hearing** - **Z01.10** - Enc for Hearing Screen - Pass - **Z01.118** - Failed Hearing Screen - **CPT** - **92551** - Hearing Eval (Pure Tone Audiometry) **Vision** - **Z01.00** - Enc for Vision Screen- Pass - **Z01.01** - Failed Vision Screen - **CPT** (only charge 1 depending on test performed) - **99173** - Vision Eval (Snellen Chart) - **99177** - SPOT Vision Screener
6 Year Visit **Well Child Exam** - **Z00.129** - Routine child exam - **Z00.121** - Routine child exam w/ abnl - **CPT** - **99383** - New Pt Preventive 5-11 yrs - **99393** - Est Pt Preventive 5-11 yrs **Vaccines** - ****Z23 -**** Encounter for Vaccines - **Flu Vaccine CPT** - **90460** - Vaccine Admin + (1 below) - **90686** - Quad Flu, IM - **90658** - Tri Flu, IM - **90660** - FluMist, Nasal **Hearing** - **Z01.10** - Enc for Hearing Screen - Pass - **Z01.118** - Failed Hearing Screen - **CPT** - **92551** - Hearing Eval (Pure Tone Audiometry) **Vision** - **Z01.00** - Enc for Vision Screen- Pass - **Z01.01** - Failed Vision Screen - **CPT** (only charge 1 depending on test performed) - **99173** - Vision Eval (Snellen Chart) - **99177** - SPOT Vision Screener
7 Year Visit **Well Child Exam** - **Z00.129** - Routine child exam - **Z00.121** - Routine child exam w/ abnl - **CPT** - **99383** - New Pt Preventive 5-11 yrs - **99393** - Est Pt Preventive 5-11 yrs **Vaccines** - ****Z23 -**** Encounter for Vaccines - **Flu Vaccine CPT** - **90460** - Vaccine Admin + (1 below) - **90686** - Quad Flu, IM - **90658** - Tri Flu, IM - **90660** - FluMist, Nasal
8 Year Visit **Well Child Exam** - **Z00.129** - Routine child exam - **Z00.121** - Routine child exam w/ abnl - **CPT** - **99383** - New Pt Preventive 5-11 yrs - **99393** - Est Pt Preventive 5-11 yrs **Vaccines** - ****Z23 -**** Encounter for Vaccines - **Flu Vaccine CPT** - **90460** - Vaccine Admin + (1 below) - **90686** - Quad Flu, IM - **90658** - Tri Flu, IM - **90660** - FluMist, Nasal **Hearing** - **Z01.10** - Enc for Hearing Screen - Pass - **Z01.118** - Failed Hearing Screen - **CPT** - **92551** - Hearing Eval (Pure Tone Audiometry) **Vision** - **Z01.00** - Enc for Vision Screen- Pass - **Z01.01** - Failed Vision Screen - **CPT** (only charge 1 depending on test performed) - **99173** - Vision Eval (Snellen Chart) - **99177** - SPOT Vision Screener
9 Year Visit **Well Child Exam** - **Z00.129** - Routine child exam - **Z00.121** - Routine child exam w/ abnl - **CPT** - **99383** - New Pt Preventive 5-11 yrs - **99393** - Est Pt Preventive 5-11 yrs **Vaccines** - ****Z23 -**** Encounter for Vaccines - **Flu Vaccine CPT** - **90460** - Vaccine Admin + (1 below) - **90686** - Quad Flu, IM - **90658** - Tri Flu, IM - **90660** - FluMist, Nasal
10 Year Visit **Well Child Exam** - **Z00.129** - Routine child exam - **Z00.121** - Routine child exam w/ abnl - **CPT** - **99383** - New Pt Preventive 5-11 yrs - **99393** - Est Pt Preventive 5-11 yrs **Vaccines** - ****Z23 -**** Encounter for Vaccines - **Flu Vaccine CPT** - **90460** - Vaccine Admin + (1 below) - **90686** - Quad Flu, IM - **90658** - Tri Flu, IM - **90660** - FluMist, Nasal **Hearing** - **Z01.10** - Enc for Hearing Screen - Pass - **Z01.118** - Failed Hearing Screen - **CPT** - **92551** - Hearing Eval (Pure Tone Audiometry) **Vision** - **Z01.00** - Enc for Vision Screen- Pass - **Z01.01** - Failed Vision Screen - **CPT** (only charge 1 depending on test performed) - **99173** - Vision Eval (Snellen Chart) - **99177** - SPOT Vision Screener **Labs (Labcorp)** - **Z13.220** - Screening for Hyperlipidemia - Labcorp Lipid Panel Order - **Z13.0** - Screening for Anemia - Labcorp Hgb Order
11 Year Visit **Well Child Exam** - **Z00.129** - Routine child exam - **Z00.121** - Routine child exam w/ abnl - **CPT** - **99383** - New Pt Preventive 5-11 yrs - **99393** - Est Pt Preventive 5-11 yrs **Vaccines** - ****Z23 -**** Encounter for Vaccines - **CPT** - **90460** - (x2) Vaccine Admin - **90461** - (x5) Vaccine Admin, add’l component - **90619** - Meningococcal Conj ACWY (Menquadfi) - **90715** - Tdap (Adacel) - **HPV (Gardasil) CPT** - **90460** - Vaccine Admin - **90651** - HPV (Gardasil) - **Flu Vaccine CPT** - **90460** - Vaccine Admin + (1 below) - **90686** - Quad Flu, IM - **90658** - Tri Flu, IM - **90660** - FluMist, Nasal
---
#### Adolescent
12 Year Visit **Well Child Exam** - **Z00.129** - Routine child exam - **Z00.121** - Routine child exam w/ abnl - **CPT** - **99384** - New Pt Preventive 12-17 yrs - **99394** - Est Pt Preventive 12-17 yrs **Vaccines** - ****Z23 -**** Encounter for Vaccines - **HPV (Gardasil) CPT** - **90460** - Vaccine Admin - **90651** - HPV (Gardasil) - **Flu Vaccine CPT** - **90460** - Vaccine Admin + (1 below) - **90686** - Quad Flu, IM - **90658** - Tri Flu, IM - **90660** - FluMist, Nasal **Hearing** - **Z01.10** - Enc for Hearing Screen - Pass - **Z01.118** - Failed Hearing Screen - **CPT** - **92551** - Hearing Eval (Pure Tone Audiometry) **Vision** - **Z01.00** - Enc for Vision Screen- Pass - **Z01.01** - Failed Vision Screen - **CPT** (only charge 1 depending on test performed) - **99173** - Vision Eval (Snellen Chart) - **99177** - SPOT Vision Screener **Depression Screening** - **Z13.31** - Screening for Depression - **CPT** - **96127** - (x2) Anxiety (GAD) / Depression (PHQ)
13-14 Year Visit **Well Child Exam** - **Z00.129** - Routine child exam - **Z00.121** - Routine child exam w/ abnl - **CPT** - **99384** - New Pt Preventive 12-17 yrs - **99394** - Est Pt Preventive 12-17 yrs **Vaccines** - ****Z23 -**** Encounter for Vaccines - **HPV (Gardasil) CPT** - **90460** - Vaccine Admin - **90651** - HPV (Gardasil) - **Flu Vaccine CPT** - **90460** - Vaccine Admin + (1 below) - **90686** - Quad Flu, IM - **90658** - Tri Flu, IM - **90660** - FluMist, Nasal **Depression Screening** - **Z13.31** - Screening for Depression - **CPT** - **96127** - (x2) Anxiety (GAD) / Depression (PHQ)
15 Year Visit **Well Child Exam** - **Z00.129** - Routine child exam - **Z00.121** - Routine child exam w/ abnl - **CPT** - **99384** - New Pt Preventive 12-17 yrs - **99394** - Est Pt Preventive 12-17 yrs **Vaccines** - ****Z23 -**** Encounter for Vaccines - **HPV (Gardasil) CPT** - **90460** - Vaccine Admin - **90651** - HPV (Gardasil) - **Flu Vaccine CPT** - **90460** - Vaccine Admin + (1 below) - **90686** - Quad Flu, IM - **90658** - Tri Flu, IM - **90660** - FluMist, Nasal **Hearing** - **Z01.10** - Enc for Hearing Screen - Pass - **Z01.118** - Failed Hearing Screen - **CPT** - **92551** - Hearing Eval (Pure Tone Audiometry) **Vision** - **Z01.00** - Enc for Vision Screen- Pass - **Z01.01** - Failed Vision Screen - **CPT** (only charge 1 depending on test performed) - **99173** - Vision Eval (Snellen Chart) - **99177** - SPOT Vision Screener **Depression Screening** - **Z13.31** - Screening for Depression - **CPT** - **96127** - (x2) Anxiety (GAD) / Depression (PHQ)
16 Year Visit **Well Child Exam** - **Z00.129** - Routine child exam - **Z00.121** - Routine child exam w/ abnl - **CPT** - **99384** - New Pt Preventive 12-17 yrs - **99394** - Est Pt Preventive 12-17 yrs **Vaccines** - ****Z23 -**** Encounter for Vaccines - **CPT** - **90460** - (x2) Vaccine Admin - **90461** - (x3) Vaccine Admin, add’l component - **90619** - Meningococcal Conj ACWY (Menquadfi) - **90621** - MenB-FHbp Meningococcal (Trumenba) - **HPV (Gardasil) CPT** - **90460** - Vaccine Admin - **90651** - HPV (Gardasil) - **Flu Vaccine CPT** - **90460** - Vaccine Admin + (1 below) - **90686** - Quad Flu, IM - **90658** - Tri Flu, IM - **90660** - FluMist, Nasal **Depression Screening** - **Z13.31** - Screening for Depression - **CPT** - **96127** - (x2) Anxiety (GAD) / Depression (PHQ)
17 Year Visit **Well Child Exam** - **Z00.129** - Routine child exam - **Z00.121** - Routine child exam w/ abnl - **CPT** - **99384** - New Pt Preventive 12-17 yrs - **99394** - Est Pt Preventive 12-17 yrs **Vaccines** - ****Z23 -**** Encounter for Vaccines - **CPT** - **90460** - Vaccine Admin - **90621** - MenB-FHbp Meningococcal (Trumenba) - **HPV (Gardasil) CPT** - **90460** - Vaccine Admin - **90651** - HPV (Gardasil) - **Flu Vaccine CPT** - **90460** - Vaccine Admin + (1 below) - **90686** - Quad Flu, IM - **90658** - Tri Flu, IM - **90660** - FluMist, Nasal **Depression Screening** - **Z13.31** - Screening for Depression - **CPT** - **96127** - (x2) Anxiety (GAD) / Depression (PHQ)
---
#### Adult
18+ Year Visit **Annual Exam** - **Z00.00** - Annual exam - **Z00.01** - Annual exam w/ abnl - **CPT** - **99385** - New Pt Preventive 18-39 yrs - **99395** - Est Pt Preventive 19-39 yrs **Vaccines** - ****Z23 -**** Encounter for Vaccines - **Flu Vaccine CPT** - **90460** - Vaccine Admin + (1 below) - **90686** - Quad Flu, IM - **90658** - Tri Flu, IM - **90660** - FluMist, Nasal **Depression Screening** - **Z13.31** - Screening for Depression - **CPT** - **96127** - (x2) Anxiety (GAD) / Depression (PHQ)
# Fast Facts: Pediatric Antibiotics - [**Acute Bacterial Conjunctivitis**](#bkmrk-acute-bacterial-conj-1) - [**Acute Bacterial Rhinosinusitis (Sinus Infection)**](#bkmrk-acute-bacterial-rhin) - [**Acute Lymphadenitis (Swollen Lymph Nodes)**](#bkmrk-acute-lymphadenitis) - [**Acute Otitis Media (AOM)**](#bkmrk-acute-otitis-media-%28) - [**Animal Bites**](#bkmrk-animal-%2F-human-bites) - [**Atypical Pneumonia (Walking Pneumonia)**](#bkmrk-atypical-pneumonia) - [**Cellulitis**](#bkmrk-cellulitis-%2F-abscess) - [**Conjunctivitis (Pink Eye)**](#bkmrk-acute-bacterial-conj-1) - [**Cystitis (Bladder Infection, Uncomplicated UTI)**](#bkmrk-cystitis-%28uncomplica) - [**Dental Abscess**](#bkmrk-dental-abscess) - [**Group A Streptococcal Pharyngitis (Strep Throat)**](#bkmrk-group-a-streptococca) - [**Human Bites**](#bkmrk-animal-%2F-human-bites) - [**Impetigo**](#bkmrk-impetigo) - [**Otitis Externa (Swimmer’s Ear)**](#bkmrk-acute-otitis-media-%28) - [**Otorrhea (Ear Discharge)**](#bkmrk-otorrhea-%2F-otitis-ex) - [**Pertussis (Whooping Cough)**](#bkmrk-pertussis) - [**Pneumonia**](#bkmrk-uncomplicated-pneumo) - [**Pyelonephritis (Kidney Infection, Febrile UTI)**](#bkmrk-pyelonephritis-%28febr) - [**Sinus Infection (Acute Bacterial Rhinosinusitis)**](#bkmrk-acute-bacterial-rhin) - [**Strep Throat (Group A Streptococcal Pharyngitis)**](#bkmrk-group-a-streptococca) - [**Swimmer’s Ear (Otitis Externa)**](#bkmrk-otorrhea-%2F-otitis-ex) - [**Walking Pneumonia (Atypical Pneumonia)**](#bkmrk-atypical-pneumonia) - [**Whooping Cough (Pertussis)**](#bkmrk-pertussis) ## **ACUTE OTITIS MEDIA (AOM)** - **Watchful waiting (WW) / Safety-Net Antibiotic Prescription (SNAP):** - Joint decision between provider and caregiver - Must have close follow-up (within 48–72 hours) if SNAP not given - Must be able to fill antibiotic prescription if signs/symptoms worsen or fail to improve in 48–72 hours from onset - **Note:** If using WW/SNAP, place a comment in prescription instructions: “**Fill only upon patient/family request**” - **Antibiotic Recommendations** - **Duration:** - <2 years or severe disease: 10 days - 2–5 years: 7 days - ≥6 years: 5 days - Recent data suggests 5 days may be sufficient for children >2 years with AOM of any severity - (Frost et al. J Pediatr. 2020 May; 220:109-115.e1). - **First-line therapy:** - **Amoxicillin** 40–50 mg/kg/dose BID (max 2000 mg/dose) - **If received amoxicillin within the past 30 days, in daycare, or with concomitant conjunctivitis:** - **Amoxicillin/clavulanate** 40–50 mg/kg/dose (amoxicillin component) PO BID (max 2000 mg amoxicillin/dose) - **Penicillin Allergy:** - **Mild/Moderate—Rashes, including hives:** - **Cefuroxime:** 250 mg PO BID (tablets only, not crushable) - **Cefdinir:** 7 mg/kg/dose PO BID (max 300 mg/dose) - **Cefpodoxime:** 5 mg/kg/dose PO BID (max 200 mg/dose) - **Cefprozil:** 15 mg/kg/dose PO BID (max 500 mg/dose) - **Ceftriaxone:** 50 mg/kg/dose IM/IV qDay x 1–3 days (max 1000 mg/dose) - **Severe—Anaphylaxis:** - **Clindamycin** 10 mg/kg/dose PO TID (max 600 mg/dose) - **Failure to improve after 48–72 hours of initial antibiotic therapy:** - **Treatment failure with amoxicillin:** - **Amoxicillin/clavulanate** 40–50 mg/kg/dose (amoxicillin component) PO BID (max 2000 mg amoxicillin/dose) - **Treatment failure with amoxicillin/clavulanate:** - **Ceftriaxone** 50 mg/kg/dose (max 1000 mg/dose) IM or IV daily x 3 days - **Clindamycin** 10 mg/kg/dose PO TID (max 600 mg/dose) PLUS: - **Cefuroxime** 250 mg PO BID - **Cefpodoxime** 5 mg/kg/dose PO BID (max 200 mg/dose) --- ## **OTORRHEA / OTITIS EXTERNA** - **Perforated Tympanic Membrane (+ Oral Antibiotics) OR AOM with Tubes:** - **Ciprodex (ciprofloxacin/dexamethasone):** 4 drops BID x 7 days for patients >6 months. - **Alternative (if Ciprodex is unavailable or cost-prohibitive):** - **Ciprofloxacin ophthalmic solution:** 2 drops +/- **dexamethasone ophthalmic solution:** 2 drops BID x 7 days for patients >6 months. - **Ofloxacin otic solution:** 5 drops BID x 10 days for patients >6 months. - **Intact Tympanic Membrane (Non-complicated Otitis Externa):** - **Ciprodex (ciprofloxacin/dexamethasone):** 4 drops BID x 7 days. - **Ofloxacin otic solution:** 5 drops BID x 10 days. - **Cortisporin otic solution:** 3 drops TID x 7 days. - **Additional Considerations:** - **Ear wick placement** may help deliver medication to the site of infection, especially in cases of significant canal swelling. - Pain management (e.g., acetaminophen or ibuprofen) is critical for patient comfort. - **Notes:** - Ensure proper administration technique to maximize effectiveness (e.g., warming drops before application and keeping the ear tilted for several minutes post-application). - If symptoms persist or worsen after 48–72 hours, reassess for alternative diagnoses or complications. --- ## **GROUP A STREPTOCOCCAL PHARYNGITIS** - **First-line therapy:** - **Amoxicillin:** 50 mg/kg/dose PO BID (max 1000 mg/day) x 10 days - **Bicillin L-A (Penicillin G benzathine):** IM - <27 kg: 600,000 U x 1 dose - ≥27 kg: 1.2 million U x 1 dose - **Penicillin VK:** PO - <27 kg: 250 mg BID-TID x 10 days - ≥27 kg: 500 mg BID-TID x 10 days - **Penicillin Allergy:** - **Mild—Rashes, including hives:** - **Cephalexin:** 20–25 mg/kg/dose PO BID (max 500 mg/dose) x 10 days - **Severe—Anaphylaxis:** - **Clindamycin:** 7 mg/kg/dose PO TID (max 300 mg/dose) x 10 days - **Azithromycin:** 12 mg/kg/dose PO qDay (max 500 mg/dose) x 5 days - **Notes:** - Azithromycin is **not recommended** unless the patient has a severe allergy to both penicillins and cephalosporins. Resistance is well-known, and treatment failure may occur. --- ## **UNCOMPLICATED PNEUMONIA** - **Duration:** - 5 days - **Note:** Shorter duration of 3–5 days may be sufficient for patients >6 months old (Kuitunen et al. Clin Infect Dis. 2023 Feb 8;76(3):e1123-e1128). - **First-line therapy:** - **Amoxicillin:** 40–50 mg/kg/dose PO BID (max 2000 mg/dose) - **Note:** Amoxicillin/clavulanate provides no additional coverage for **Streptococcus pneumoniae** and is not recommended as a first-line agent. - **Penicillin Allergy:** - **Mild/Moderate—Rashes, including hives:** - **Cefuroxime:** 250–500 mg PO BID (for children able to swallow pills; only available in tablets) - **Cefpodoxime:** 5 mg/kg/dose PO BID (max 200 mg/dose) - **Cefprozil:** 15 mg/kg/dose PO BID (max 500 mg/dose) - **Note:** Cefdinir is NOT recommended for empiric treatment of community-acquired pneumonia due to reduced effectiveness against **Streptococcus pneumoniae**. Clindamycin is preferred if above options are unavailable. - **Severe—Anaphylaxis ± Cephalosporin Allergy:** - **Clindamycin:** 10 mg/kg/dose PO TID (max 600 mg/dose) - **Severe—Anaphylaxis + Cephalosporin Allergy + Intolerance of Clindamycin:** - **Levofloxacin:** - Ages 6 months–5 years: 8–10 mg/kg/dose PO BID - ≥5 years: 16–20 mg/kg/dose PO QD (max 750 mg/day) --- ## **ATYPICAL PNEUMONIA** - **Duration:** - 5–7 days - **First-line therapy:** - **Azithromycin:** - Day 1: 10 mg/kg/dose PO (max 500 mg/dose) - Days 2–5: 5 mg/kg/dose PO qDay (max 250 mg/dose) - **Note:** Resistance to azithromycin is significant among typical bacterial pathogens, especially **Streptococcus pneumoniae**. - **Alternatives (without azithromycin):** - **Levofloxacin:** - Ages 6 months–5 years: 8–10 mg/kg/dose PO BID - ≥5 years: 16–20 mg/kg/dose PO QD (max 750 mg/day) - **Doxycycline (for children ≥8 years):** - 2 mg/kg/dose PO BID (max 100 mg/dose) - **Notes:** - **Consider atypical pneumonia** in adolescents with bilateral or diffuse pulmonary involvement and/or prolonged symptoms such as persistent cough and fever. - Levofloxacin and doxycycline provide excellent atypical pathogen coverage and do not require additional macrolides. --- ## **ACUTE BACTERIAL RHINOSINUSITIS (ABRS)** - **Criteria for Diagnosis:** - Presumptive diagnosis of ABRS can be made if a patient with acute upper respiratory tract infection (URI) presents with ONE of the following: - **Persistent illness** (e.g., nasal discharge, daytime cough, or both) lasting >10 days without improvement. - **Worsening course after initial improvement** (e.g., new onset nasal discharge, daytime cough, or fever). - **Severe onset** (e.g., fever ≥102.2°F and purulent nasal discharge) lasting at least 3 consecutive days. - **Duration:** - 5–7 days - **First-line therapy:** - **Mild-moderate disease (≥2 years, no daycare, no antibiotics in past 30 days):** - **Amoxicillin:** 45–50 mg/kg PO BID (max 2000 mg/dose). - **Severe disease or mild-moderate disease with any of the following: <2 years, daycare attendance, or recent antibiotic use:** - **Amoxicillin-clavulanate:** 40–50 mg/kg/dose (amoxicillin component) PO BID (max 2000 mg/dose). - **Penicillin Allergy:** - **Mild/Moderate—Rashes, including hives:** - **Cefpodoxime:** 5 mg/kg/dose PO BID (max 200 mg/dose). - **Cefuroxime:** 250 mg PO BID (for children able to swallow tablets; not available in liquid form). - **Cefixime:** 4 mg/kg/dose PO BID (max 200 mg/dose) PLUS **Clindamycin:** 10 mg/kg/dose PO TID (max 600 mg/dose). - **Severe—Anaphylaxis ± Cephalosporin Allergy:** - **Levofloxacin:** - Ages 6 months–5 years: 10 mg/kg/dose PO BID. - ≥5 years: 20 mg/kg/dose PO QD (max 500 mg/day). - **Notes:** - If symptoms worsen or fail to improve after 48–72 hours, reassess for complications or switch to second-line therapy. - Consider consulting an infectious diseases physician for complex or recurrent cases. --- ## **CYSTITIS (UNCOMPLICATED UTI)** - **Duration:** - 3–5 days - **First-line therapy:** - **Cephalexin:** 50 mg/kg/day PO divided TID (max 1500 mg/day). - **Cefixime:** 8 mg/kg/dose PO qDay (max 400 mg/day). - **Severe Penicillin/Cephalosporin Allergy (e.g., Anaphylaxis):** - **Trimethoprim-Sulfamethoxazole (TMP/SMX):** - 3–6 mg TMP/kg/dose PO BID (max 160 mg TMP/dose). - **Nitrofurantoin** (for cystitis only): - **Macrocrystal (Macrodantin or Furadantin):** 1.25–1.75 mg/kg/dose PO Q6H x 5–7 days (max 100 mg/dose). - **Macrocrystal/monohydrate (Macrobid):** 100 mg PO BID x 5–7 days (**adolescents only**). - **Notes:** - **Nitrofurantoin** should be used only for lower urinary tract infections and avoided in suspected pyelonephritis or febrile UTIs. - Avoid TMP/SMX in infants <2 months due to risk of kernicterus. - Consider urine culture and sensitivity for recurrent UTIs or treatment failures. --- ## **PYELONEPHRITIS (FEBRILE UTI)** - **Indications for Admission:** - Age <2 months. - Ill appearance or poor oral intake. - Inability to tolerate oral antibiotics. - Vomiting, immune compromise, or urinary tract obstruction. - Positive culture for bacteria resistant to oral antibiotics. - **Duration:** - 7–10 days. - **Note:** Shorter duration of 5 days may be sufficient for patients >2 months (Zaoutis et al., JAMA Pediatr. 2023 Aug 1;177(8):782-789). - **First-line therapy:** - **Cephalexin:** 25–33 mg/kg/dose PO TID (max 3000 mg/day). - **Cefixime:** 8 mg/kg/day PO qDay (max 400 mg/day). - **Severe Penicillin/Cephalosporin Allergy (e.g., Anaphylaxis):** - **Trimethoprim-Sulfamethoxazole (TMP/SMX):** - 3–6 mg TMP/kg/dose PO BID (max 160 mg TMP/dose). - **Ciprofloxacin:** - 10–20 mg/kg/dose PO BID (max 750 mg/dose). - **Notes:** - **Cefdinir** is not recommended for pediatric UTIs due to poor urine concentration in children. - Evaluate for potential complications, such as renal scarring or obstruction, especially in recurrent infections. - Obtain urine culture and sensitivity to guide therapy. --- ## **IMPETIGO** - **Treatment based on severity:** - **Mild (<5 lesions - topical therapy):** - **Mupirocin:** Apply TID x 5 days. - **Extensive (>5 lesions or lesions near the mouth - systemic therapy):** - **Cephalexin:** 17 mg/kg/dose PO TID (max 500 mg/dose) x 7 days. - **If MRSA is suspected or with severe penicillin/cephalosporin allergy:** - **Clindamycin:** 7 mg/kg/dose PO TID (max 450 mg/dose) x 7 days. - **Trimethoprim-Sulfamethoxazole (TMP/SMX):** - 4–6 mg TMP/kg/dose PO BID (max 160 mg TMP/dose) x 7 days. - **Notes:** - Systemic antibiotics are preferred if lesions are numerous, involve the mouth or mucosal areas, or in cases with signs of systemic infection. - Educate caregivers about proper hygiene to prevent the spread, as impetigo is highly contagious. --- ## **CELLULITIS / ABSCESS** - **First-line therapy:** - **Cephalexin:** 17 mg/kg/dose PO TID (max 500 mg/dose) x 5 days. - **Amoxicillin-clavulanate:** 22.5 mg/kg/dose (amoxicillin component) PO BID (max 875 mg/dose). - **If MRSA is suspected, abscess is present, or in cases of penicillin/cephalosporin allergy:** - **Clindamycin:** 10 mg/kg/dose PO TID (max 450 mg/dose) x 5 days. - **Trimethoprim-Sulfamethoxazole (TMP/SMX):** - 4–6 mg TMP/kg/dose PO BID (max 160 mg TMP/dose) x 5 days. - **Notes:** - For **abscesses**, incision and drainage (I&D) is the primary treatment; antibiotics may be considered based on the severity or associated cellulitis. - Reassess therapy if no improvement is noted after 48–72 hours. - Obtain cultures in cases of recurrent abscesses, systemic symptoms, or immunocompromised patients to guide therapy. --- ## **ANIMAL / HUMAN BITES** - **First-line therapy:** - **Amoxicillin-clavulanate (Augmentin):** 22.5 mg/kg/dose (amoxicillin component) PO BID (max 875 mg amoxicillin/dose). - **Duration:** - **Prophylaxis:** 3 days. - **Treatment:** 5–7 days. - **Penicillin Allergy:** - **Clindamycin:** 10 mg/kg/dose PO TID (max 450 mg/dose) PLUS one of the following: - **Trimethoprim-Sulfamethoxazole (TMP/SMX):** 5 mg TMP/kg/dose PO BID (max 160 mg TMP/dose). - **Doxycycline:** 2.2 mg/kg/dose PO BID (max 100 mg/dose). - **Additional Considerations:** - **Tetanus booster:** Ensure vaccination status is updated. - **Rabies prophylaxis:** Assess need based on the animal and circumstances of the bite. - **Notes:** - Antibiotic prophylaxis is recommended for high-risk wounds, such as deep punctures, crush injuries, or bites on the hands, face, or genitals. - Monitor for signs of infection, including increasing redness, swelling, pain, or systemic symptoms. --- ## **DENTAL ABSCESS** - **First-line therapy:** - **Amoxicillin:** 17 mg/kg/dose PO TID (max 500 mg/dose) x 10 days. - **Amoxicillin-clavulanate (Augmentin):** 25 mg/kg/dose (amoxicillin component) PO BID (max 875 mg amoxicillin/dose) x 10 days. - **If buccal involvement or penicillin allergy:** - **Clindamycin:** 10 mg/kg/dose PO TID (max 450 mg/dose) x 10 days. - **Additional Considerations:** - Incision and drainage (I&D) is often necessary for definitive management. - Dental consultation is recommended to address the underlying cause and prevent recurrence. - **Notes:** - For systemic symptoms (e.g., fever, swelling extending into facial spaces), hospitalization and IV antibiotics may be required. - Encourage dental hygiene and follow-up care to prevent complications or recurrence. --- ## **ACUTE LYMPHADENITIS** - **First-line therapy:** - **Cephalexin:** 17–25 mg/kg/dose PO TID (max 1000 mg/dose) x 7–10 days. - **Amoxicillin-clavulanate (Augmentin):** 22.5 mg/kg/dose (amoxicillin component) PO BID (max 875 mg amoxicillin/dose) x 7–10 days. - **If MRSA is suspected or with severe penicillin/cephalosporin allergy:** - **Clindamycin:** 10 mg/kg/dose PO TID (max 450 mg/dose) x 7–10 days. - **If Bartonella henselae (cat-scratch disease) is suspected:** - **Azithromycin:** 10 mg/kg/dose PO qDay (max 500 mg/dose) x 5 days. - **Additional Considerations:** - Obtain cultures or imaging (e.g., ultrasound) if abscess formation is suspected. - Monitor closely for systemic symptoms such as fever, weight loss, or night sweats, which may warrant further investigation for atypical infections or malignancy. - **Notes:** - Typical bacterial causes include **Staphylococcus aureus** and **Streptococcus pyogenes**. - For children with recurrent or persistent lymphadenitis, consider consultation with an infectious diseases specialist. --- ## **ACUTE BACTERIAL CONJUNCTIVITIS** - **Infants (especially <2 months):** - **Erythromycin ointment (5 mg/g):** Apply 1 cm to the affected eye QID for 5 days. - **Polymyxin B ointment:** Apply 1.25 cm to the affected eye QID for 5 days. - **Children and adolescents:** - **Polymyxin B solution:** 1 drop in the affected eye QID for 7 days. - **Alternative topical therapies:** - **Tobramycin (0.3%) ophthalmic solution:** Instill 1–2 drops into the affected eye every 4 hours. - **Azithromycin (1%) ophthalmic solution:** - Instill 1 drop into the affected eye BID (8–12 hours apart) on days 1–2. - Then, instill 1 drop daily into the affected eye on days 3–7. - **Note:** More expensive and harder to find than other alternatives. - **If corneal involvement or patient wears contact lenses:** - Consider alternatives with broader gram-negative coverage: - **Ciprofloxacin (0.3%) ophthalmic drops:** Instill 1–2 drops in the affected eye 4 times daily. - **Ofloxacin (0.3%) ophthalmic drops:** Instill 1–2 drops in the affected eye 4 times daily. - **Notes:** - Avoid ophthalmic solutions containing neomycin due to a high incidence of allergic reactions. - For severe cases or if no improvement after 48 hours, consider bacterial resistance or alternative diagnoses such as viral conjunctivitis. --- ## **PERTUSSIS**

**Reportable - Must Notify Louisiana Department of Health; Must stay home until completed antibiotics**

- **Indications for Treatment:** - Confirmed or suspected pertussis cases. - Prophylaxis for close contacts of pertussis cases, especially high-risk individuals (e.g., infants, pregnant women, or those with immunocompromised household members). - **Duration:** - 5–7 days depending on the selected antibiotic. - **First-line therapy (macrolides):** - **Azithromycin:** - Infants <6 months: 10 mg/kg/dose PO qDay x 5 days - ≥6 months: - Day 1: 10 mg/kg/dose PO (max 500 mg/dose) - Days 2–5: 5 mg/kg/dose PO qDay (max 250 mg/dose) - **Clarithromycin:** - 7.5 mg/kg/dose PO BID (max 500 mg/dose) x 7 days - **Alternative therapy (if macrolides are contraindicated):** - **Trimethoprim-Sulfamethoxazole (TMP/SMX):** - 4–6 mg TMP/kg/dose PO BID (max 160 mg TMP/dose) x 14 days - **Notes:** - **Azithromycin** is preferred for infants <1 month due to safety concerns with erythromycin (risk of hypertrophic pyloric stenosis). - **TMP/SMX** should be avoided in infants <2 months due to the risk of kernicterus. - Early treatment is critical to limit transmission, but treatment after the paroxysmal stage may not alter the course of symptoms. # Immunization Station
**Age** **Immunization**
**2 months** **[Vaxelis (DTaP-IPV/HepB/Hib)](#bkmrk-vaxelis-%28dtap-ipv%2Fhe), [Vaxneuvance (PCV15)](#bkmrk-vaxneuvance-%28pcv15%29), [RotaTeq (RV5)](#bkmrk-rotateq-%28rv5%29)**
**4 months** **[Vaxelis (DTaP-IPV/HepB/Hib)](#bkmrk-vaxelis-%28dtap-ipv%2Fhe), [Vaxneuvance (PCV15)](#bkmrk-vaxneuvance-%28pcv15%29), [RotaTeq (RV5)](#bkmrk-rotateq-%28rv5%29)**
**6 months** **[Vaxelis (DTaP-IPV/HepB/Hib)](#bkmrk-vaxelis-%28dtap-ipv%2Fhe), [Vaxneuvance (PCV15)](#bkmrk-vaxneuvance-%28pcv15%29), [RotaTeq (RV5)](#bkmrk-rotateq-%28rv5%29), [flu (eligible)](#bkmrk-flu-vaccine)**
**12 months** **[M-M-R II](#bkmrk-m-m-r-ii-%28measles%2C-m), [Varivax (Varicella)](#bkmrk-varivax-%28varicella%29), [Vaqta (Hep A)](#bkmrk-vaqta-%28hep-a%29)**
**15 months** **[Vaxneuvance (PCV15)](#bkmrk-vaxneuvance-%28pcv15%29), [Pentacel (DTaP-IPV/Hib)](#bkmrk-pentacel-%28dtap-ipv%2Fh)**
**18 months** **[Vaqta (Hep A)](#bkmrk-vaqta-%28hep-a%29)**
**4 years** **[ProQuad (MMR & Varicella)](#bkmrk-proquad-%28mmr-%26-varic), [Quadracel (DTaP-IPV)](#bkmrk-quadracel-%28dtap-ipv%29)**
**11 years** **[Adacel (Tdap)](#bkmrk-adacel-%28tdap%29), [Menquadfi (ACWY)](#bkmrk-menquadfi-%28meningoco), [Gardasil (HPV) ](#bkmrk-gardasil-%28hpv%29)**
**16 years** **[Menquadfi (ACWY)](#bkmrk-menquadfi-%28meningoco), [Trumenba (Meningococcal B)](#bkmrk-trumenba-%28meningococ)**
--- ## **Adacel (Tdap)** - **Number of doses:** 1 dose (booster) at 11–12 years old, then every 10 years. - **Spacing:** - Administer at least 5 years after the last tetanus-containing vaccine. - **Major teaching:** - Protects against tetanus, diphtheria, and pertussis. - Critical for adolescents and adults to prevent pertussis transmission to infants. - May cause mild pain or swelling at the injection site. --- ## **Gardasil (HPV)** - **Number of doses:** - 2 doses (6–12 months apart) for individuals starting at age 11–12 and under 15 years. - 3 doses (0, 1–2, and 6 months) for individuals ≥15 years or immunocompromised. - **Spacing:** - Ensure a minimum interval of 5 months between the first and last doses. - **Major teaching:** - Protects against HPV-related cancers and genital warts. - Most effective when given before exposure to HPV. - May cause fainting; observe adolescents for 15 minutes post-vaccination. --- ## **M-M-R II (Measles, Mumps, Rubella)** - **Number of doses:** 2 doses (at 12–15 months and 4–6 years). - **Spacing:** - Minimum interval: 4 weeks between doses. - **Major teaching:** - Live vaccine; avoid in immunocompromised individuals or during pregnancy. - May cause mild fever or rash 1–2 weeks after vaccination. - Critical for preventing measles outbreaks. --- ## **Menquadfi (Meningococcal ACWY)** - **Number of doses:** 2 doses (at 11–12 years and 16 years). - **Spacing:** - At least 8 weeks between doses if additional doses are required for high-risk individuals. - **Major teaching:** - Protects against meningococcal disease (ACWY serogroups). - Recommended for college students living in dormitories. - May cause mild soreness at the injection site. --- ## **Pentacel (DTaP-IPV/Hib)** - **Number of doses:** 4 doses (at 2, 4, 6, and 15–18 months). - **Spacing:** - Minimum interval of 4 weeks between doses in the primary series (2, 4, and 6 months). - Booster dose at 15–18 months, spaced at least 6 months after the third dose. - **Major teaching:** - Combines protection against 5 diseases: diphtheria, tetanus, pertussis, polio, and *Haemophilus influenzae* type b (Hib). - Reduces the number of injections needed at each visit. - Common side effects include mild fever, irritability, and injection site redness/swelling. - Ensure parents are aware of the importance of completing the series for full protection against these diseases. --- ## **ProQuad (MMR & Varicella)** - **Number of doses:** 2 doses (at 4–6 years and earlier if needed). - **Spacing:** - Minimum interval of 3 months between doses. - **Major teaching:** - Combines MMR and Varicella for convenience. - Live vaccine; avoid in pregnancy or severe immunosuppression. - Mild rash or fever may occur. --- ## **Quadracel (DTaP-IPV)** - **Number of doses:** 1 dose at 4–6 years. - **Spacing:** - Must be spaced at least 6 months after the previous DTaP-IPV dose. - **Major teaching:** - Protects against diphtheria, tetanus, pertussis, and polio. - Booster dose completes the series before entering school. --- ## **RotaTeq (RV5)** - **Number of doses:** 3 doses (at 2, 4, and 6 months). - **Spacing:** - Minimum interval of 4 weeks between doses. - Final dose must be administered before 8 months of age. - **Major teaching:** - Protects against severe rotavirus gastroenteritis. - Oral vaccine; no injection required. - Common side effects include mild diarrhea or fussiness. --- ## **Trumenba (Meningococcal B)** - **Number of doses:** 2 doses (0 and 6 months apart). - **Spacing:** - A 3-dose schedule (0, 1–2, and 6 months) may be recommended for certain high-risk groups. - **Major teaching:** - Protects against meningococcal B disease, which can cause rapid and severe infections. - Recommended for individuals 16–23 years old, especially those in high-risk settings (e.g., college campuses). --- ## **Vaqta (Hep A)** - **Number of doses:** 2 doses (at 12 months and 18 months). - **Spacing:** - At least 6 months between doses. - **Major teaching:** - Protects against hepatitis A, a liver infection spread by contaminated food/water. - Common side effects include mild injection site soreness. --- ## **Varivax (Varicella)** - **Number of doses:** 2 doses (at 12–15 months and 4–6 years). - **Spacing:** - Minimum interval of 3 months between doses. - **Major teaching:** - Live vaccine; avoid in pregnancy or severe immunosuppression. - Mild rash or fever may occur 1–2 weeks after vaccination. --- ## **Vaxelis (DTaP-IPV/HepB/Hib)** - **Number of doses:** 3 doses (at 2, 4, and 6 months). - **Spacing:** - Minimum interval of 4 weeks between doses. - **Major teaching:** - Protects against six diseases (diphtheria, tetanus, pertussis, polio, hepatitis B, and Haemophilus influenzae type b). - May cause mild fever, soreness, or swelling at the injection site. --- ## **Vaxneuvance (PCV15)** - **Number of doses:** 4 doses (at 2, 4, 6, and 15 months). - **Spacing:** - Minimum interval of 4 weeks between primary doses. - Booster dose recommended at least 8 weeks after the 3rd dose. - **Major teaching:** - Protects against 15 serotypes of *Streptococcus pneumoniae*, which can cause pneumonia, meningitis, and bacteremia. - May cause mild fever or irritability post-vaccination. --- ## **Flu Vaccine** ### **FluMist (Live Attenuated Influenza Vaccine - LAIV4)** - **Type:** Live attenuated vaccine administered intranasally. - **Age indications:** Approved for healthy individuals aged 2–49 years. - **Effectiveness:** Comparable to the flu shot in most years but may vary depending on the season and strains. - **Contraindications:** - Children <2 years or adults ≥50 years. - Pregnant individuals. - Immunocompromised individuals or close contacts of severely immunocompromised individuals (e.g., bone marrow transplant patients in protective isolation). - Children 2–4 years with asthma or wheezing in the past 12 months. - Severe allergy to any FluMist component. - **Major teaching:** - Avoid in individuals taking aspirin or salicylate-containing medications due to the risk of Reye's syndrome. - Mild side effects include runny nose, sore throat, or headache. ### **Flu Shot (Inactivated Influenza Vaccine - IIV4)** - **Type:** Inactivated vaccine administered via intramuscular injection. - **Age indications:** Approved for individuals 6 months and older, including pregnant individuals and those with chronic health conditions. - **Effectiveness:** Provides broad protection against circulating influenza strains; updated yearly to match predicted strains. - **Contraindications:** - Severe allergy to any flu shot component, including egg protein (though egg-free formulations are available). - **Major teaching:** - Common side effects include mild soreness or swelling at the injection site, low-grade fever, or fatigue. - Safe for individuals with chronic medical conditions or weakened immune systems. - For children <9 years receiving the flu vaccine for the first time, 2 doses are required at least 4 weeks apart. **Key Differences:**
Aspect**FluMist (Nasal Spray)****Flu Shot (Injection)**
**Type of Vaccine**Live attenuatedInactivated
**Route of Administration**Nasal sprayIntramuscular injection
**Age Range**2–49 years6 months and older
**Pregnancy Safe?**NoYes
**Immunocompromised Use?**NoYes
**Common Side Effects**Runny nose, sore throat, headacheSoreness, redness, low-grade fever
# OTC Dose Decoder - [Tylenol](#bkmrk-tylenol-%28acetaminoph) - [Motrin or Advil](#bkmrk-motrin-or-advil-%28ibu) - **Antihistamines (Allergies):** - [Benadryl](#bkmrk-benadryl-%28diphenhydr) - [Zyrtec](#bkmrk-zyrtec-%28cetirizine%29) - **Decongestants:** - [Sudafed](#bkmrk-sudafed-%28pseudoephed) - [Mucinex Stuffy Nose & Chest Congestion Liquid](#bkmrk-mucinex-cold) - **Cough Suppressants and Expectorants:** - [Robitussin-DM](#bkmrk-robitussin-dm-%28dextr) - [Mucinex Children's Cough Liquid](#bkmrk-mucinex-children%27s-c) - **Combination Medications for Colds:** - [Robitussin](#bkmrk-robitussin-%28guaifene) - [Children's Dimetapp](#bkmrk-children%27s-dimetapp-) ## **Tylenol** **(Acetaminophen)**

**Use for: Fever, pain relief, teething**

**Not to be given if under 2 months (unless cleared with pediatrician)** Can be repeated every 4 hours as needed Do not give more than 5 doses in 24 hours

**Weight (lbs)****Dose (mgs)****Infant Oral Suspension (160 mg/5 ml)****Child Oral Suspension (160 mg/5 ml)****Chewable (80 mg tab)****Jr. Strength (160 mg tab)****Adult Tab (325 mg)**
6 - 11401.25 ml = 1/4 tsp----
12 - 17802.5 ml = 1/2 tsp2.5 ml = 1/2 tsp---
18 - 221203.75 ml = 3/4 tsp3.75 ml = 3/4 tsp1 1/2 tabs--
23 - 351605 ml = 1 tsp5 ml = 1 tsp2 tabs1 tab-
36 - 472407.5 ml = 1 1/2 tsp7.5 ml = 1 1/2 tsp3 tabs1 1/2 tabs-
48 - 5932010 ml = 2 tsp10 ml = 2 tsp4 tabs2 tabs1 tab
60 - 7140012.5 ml = 2 1/2 tsp12.5 ml = 2 1/2 tsp5 tabs2 1/2 tabs1 tab
72 - 9548015 ml = 3 tsp15 ml = 3 tsp6 tabs3 tabs1 1/2 tabs
96+64020 ml = 4 tsp20 ml = 4 tsp8 tabs4 tabs2 tabs
--- ## **Motrin or Advil** **(Ibuprofen)**

Use for: **Fever, pain relief, teething**

**Not to be given if under 12 pounds or 6 months** Best if not given on an empty stomach Can be repeated every 6 hours as needed

**Weight (lbs)****Dose (mgs)****Infant Oral Drops (50 mg/1.25 ml)****Child Oral Suspension (100 mg/5 ml)****Chewable (100 mg tab)****Jr. Strength (100 mg tab)****Adult Tab (200 mg)**
12 - 17501.25 ml = 1 dropper2.5 ml = 1/2 tsp------
18 - 23751.875 ml = 1 1/2 dropper3.75 ml = 3/4 tsp------
24 - 351002.5 ml = 2 droppers5 ml = 1 tsp1 tab1 tab--
36 - 47150--7.5 ml = 1 1/2 tsp1 1/2 tabs1 1/2 tabs--
48 - 59200--10 ml = 2 tsp2 tabs2 tabs1 tab
60 - 71250--12.5 ml = 2 1/2 tsp2 1/2 tabs2 1/2 tabs1 tab
72 - 95300--15 ml = 3 tsp3 tabs3 tabs1 1/2 tabs
96+400--20 ml = 4 tsp4 tabs4 tabs2 tabs
--- ## **Benadryl** **(Diphenhydramine)**

Use for: **Allergic reactions, itchy hives, seasonal allergies**

**Not to be given if under 6 months of age** Can be repeated every 6 hours as needed Maximum of 4 doses in 24 hours **Caution:** May cause drowsiness

**Weight (lbs)****Suspension (12.5 mg/5 ml)****Chewable (12.5 mg tab)****FastMelts (12.5 mg tab)****Tab/Cap (25 mg)**
12 - 192.5 ml = 1/2 tsp---
20 - 263.75 ml = 3/4 tsp---
27 - 395 ml = 1 tsp1 tab1 tab-
40 - 527.5 ml = 1 1/2 tsp1 tab1 tab-
53 - 6710 ml = 2 tsp2 tabs2 tabs1 tab/cap
68 - 7912.5 ml = 2 1/2 tsp2 tabs2 tabs1 tab/cap
80 - 9515 ml = 3 tsp3 tabs3 tabs1 tab/cap
96+20 ml = 4 tsp4 tabs4 tabs2 tabs/caps
--- ## **Zyrtec** **(Cetirizine)**

Use for: **Allergic reactions, itchy hives, seasonal allergies, sinus drip, nasal congestion**

**Not to be given if under 6 months of age** Best if given before bedtime. Only given once a day **Caution:**May cause drowsiness

**Age****Dose (mL)**
6-12 months2.5 mL
1-2 years2.5-3.75 mL
2-3 years3.75 mL
3-4 years5 mL
4-5 years5-7.5 mL
6 years & older7.5-10 mL
--- ## **Robitussin-DM** **(Dextromethorphan, Guaifenesin)**

Use for: **Nonproductive (dry) cough, to suppress the cough reflex and reduce the urge to cough, providing relief from persistent or irritating coughing.**

**Not to be given if under 2 years of age** Can be repeated every 4 hours as needed Maximum of 6 doses in 24 hours

**Age****Dose (mL)**
2-4 years2.5 mL
4-6 years3.75 mL
6-9 years5 mL
9-12 years7.5 mL
12 & older10 mL
--- ## **Robitussin** **(Guaifenesin)**

Use for: **Productive (wet) cough, chest congestion, thick nasal congestion with mucus or phlegm present, to thin and loosen mucus, making it easier to cough up and clear from the airways.**

**Not to be given if under 2 years of age** Can be repeated every 4 hours as needed Maximum of 6 doses in 24 hours

**Age****Dose (mL)**
2-4 years2.5-3.75 mL
4-6 years3.75-5 mL
6-9 years5-7.5 mL
12 & over10-20 mL
--- ## **Children's Dimetapp** #### **Cold & Allergy** **Brompheniramine maleate (antihistamine)** -

Use **Cold & Allergy** for: **Nasal congestion, Runny nose, Itchy eyes, Watery eyes, Sneezing, & Itchy throat**

#### **Cold & Cough** **Brompheniramine maleate (antihistamine) & Dextromethorphan HBr (cough suppressant)** -

Use **Cold & Cough** for: **Runny nose, Itchy eyes, Watery eyes, Sneezing, & nonproductive (dry) cough**

**Not to be given if under 2 years of age** Can be repeated every 4 hours as needed Maximum of 4 doses in 24 hours

**Age****Dose (mL)**
2-4 years5 mL
4-6 years7.5 mL
6-9 years10 mL
9-12 years15 mL
12 & older20 mL
--- ## **Mucinex Children's Cough Liquid** **(Guaifenesin 100 mg/5 mL, Dextromethorphan HBr 5 mg/5 mL)**

Use for: **Cough relief, chest congestion, thinning and loosening mucus**

**Not to be given if under 2 years of age** Can be repeated every 4 hours as needed Maximum of 6 doses in 24 hours Stop use and consult a doctor if cough persists for more than 7 days or is accompanied by fever, rash, or persistent headache

**Age****Dose (mL)**
2-4 years2.5-3.75 mL
4-6 years3.75-5 mL
6-9 years5-7.5 mL
9-12 years7.5-10 mL
12 & over10-15 mL
--- ## **Mucinex - Children's Stuffy Nose & Chest Congestion Liquid**
**(Guaifenesin & Phenylephrine)**

Use for: **Productive (wet) cough, chest congestion, thick nasal congestion with mucus or phlegm present, to thin and loosen mucus, making it easier to cough up and clear from the airways.**

**Not to be given if under 9 months of age** Can be repeated every 4 hours as needed Maximum of 6 doses in 24 hours

**Age****Dose (mL)**
9-12 months1 mL
12-15 months1.25 mL
15-18 months1.6 mL
18-24 months2 mL
2-4 years2.5-3.75 mL
4-6 years3.75-5 mL
6-9 years5-7.5 mL
9-12 years7.5-10 mL
12 & over10-15 mL
--- ## **Sudafed** **(Pseudoephedrine HCl)**

**Use for:** Nasal congestion, sinus pressure, stuffy nose due to colds or allergies

**Not to be given to children under 4 years of age** Do not use with MAOIs or within 14 days of stopping MAOI treatment Consult a doctor before use if you have heart disease, high blood pressure, diabetes, or other medical conditions Follow recommended dosages and do not exceed the maximum daily dose

**Age** **Children's Sudafed Liquid** **(15 mg/5 mL)** **Sudafed Sinus Congestion** **(30 mg tabs)** **Sudafed PE Sinus Congestion** **(10 mg tabs)**
4–5 years5 mL every 4–6 hours (Max: 4 doses in 24 hours) --
6–11 years10 mL every 4–6 hours (Max: 4 doses in 24 hours) 1 tablet every 4–6 hours (Max: 4 tablets in 24 hours) -
12+ years 20 mL every 4–6 hours (Max: 4 doses in 24 hours) 2 tablets every 4–6 hours (Max: 8 tablets in 24 hours) 1 tablet every 4 hours (Max: 6 tablets in 24 hours)
# ADHD Meds
[![Asset 43@3x.png](https://wiki.joshnp.com/uploads/images/gallery/2025-01/scaled-1680-/asset-43-at-3x.png)](https://wiki.joshnp.com/books/treatment-and-management/page/medication-by-form "Medication by Form") #### Meds by Form [![Asset 4@3x.png](https://wiki.joshnp.com/uploads/images/gallery/2025-01/scaled-1680-/asset-4-at-3x.png)](https://wiki.joshnp.com/books/treatment-and-management/page/stimulants-by-duration "Medication by Duration") #### Meds by Duration
[![Asset 3@3x.png](https://wiki.joshnp.com/uploads/images/gallery/2025-01/scaled-1680-/asset-3-at-3x.png)](https://wiki.joshnp.com/books/drug-library "Drug Library") #### Meds (Alphabetical) [![Asset 1@3x.png](https://wiki.joshnp.com/uploads/images/gallery/2025-01/scaled-1680-/asset-1-at-3x.png)](https://wiki.joshnp.com/books/treatment-and-management/chapter/co-occuring-conditions "Co-Occuring Conditions") #### Co-Occuring Conditions
# Screening & Learning Vault ## Periodicity Schedule ##### [Periodicity Schedule](https://wiki.joshnp.com/attachments/63) ## Screening Tools ##### [ASQ (Development)](https://wiki.joshnp.com/attachments/57?open=true) ##### [MACHAT (Autism)](https://wiki.joshnp.com/attachments/58?open=true) ##### [PHQ/GAD (Anxiety/Depression)](https://wiki.joshnp.com/attachments/59?open=true) ##### [SCARED (Anxiety)](https://wiki.joshnp.com/attachments/60?open=true) ##### [SWYC (Development)](https://wiki.joshnp.com/attachments/61?open=true) ##### [Vanderbilt (ADHD)](https://wiki.joshnp.com/attachments/62?open=true) ## Reference Material