Intake Form (Checklist) for CEASE Clients Please check anything that applies on this list along with the dates!
Important health and medication for child’s father and mother before pregnancy:
Vaccinations:* (Tropics) vaccines: DTP, typhoid (typhoid fever), yellow fever, Hep A, Hep B* Cholera, rabies (rabies) or Mantoux (TB control through arm prick)* Tetanus vaccine in repeat injuries (tetanus toxoid)* Hepatitis B vaccine - for doctors, nurses, caregivers, etc. or as tropical vaccine. * Malaria Prevention: Malarone, Lariam* Diseases that have left a lasting disruption: Lyme, Mono, colitis, asthma, epilepsy, depression, migraines, etc. and their treatment* Drugs (antibiotics, sleeping pills, acetaminophen)* Anesthesia* Operations* Echo, CT scan, MRI* Dental treatments: eg Amalgam fillings, anesthesia* IVF (In vitro fertilization) : Clomid , Pregnil (Chorionic Gonadotropin)* Chronic medication in asthma, colitis, epilepsy or other diseases* Antihypertensives (nifedipine, .)* Use of cortisone ointment (hydrocortisone)* Antihistamines for hay fever * Medicines to prevent vomiting* Antacids: such as Maalox or Amphojel (aluminum hydroxide)* Iron for anemia * Vaginal Tablets for fungal infection
* Highly emotional events sometimes sedative drugs * Alcohol * Drugs * Vinyl in the bedroom or other rooms in the house * Cooking in aluminum pans * Frequent travel by plane (or work as a flight attendant or pilot) * High amounts of mobile phone usage * Wireless antenna (WiFi) wireless internet at home. Important health and medication for the child’s mother during the pregnancy and unborn child:
Vaccinations:* (Tropics) vaccines: DTP, typhoid (typhoid fever), yellow fever, Hep A, Hep B* Cholera, rabies (rabies) or Mantoux (TB control through arm prick)* Tetanus vaccine in repeat injuries (tetanus toxoid)* Hepatitis B vaccine - for doctors, nurses, caregivers, etc. or as tropical vaccine. * Malaria Prevention: Malarone, Lariam* Diseases that a lasting disruption left: Pfeiffer, Lyme, colitis, asthma, epilepsy, depression, migraines, etc. And their treatment. * Drugs (antibiotics, sleeping pills, acetaminophen)* Anesthesia* Operations* Amniocentesis* Echo, CT scan, MRI* Dental treatments: i.e.-Amalgam fillings, anesthesia* Injection between 28-30 weeks of anti-Rhesus (D)-globulin (or rhedquin rhophylac)* Chronic medication in asthma, colitis, epilepsy or other diseases* Antihypertensives (nifedipine, .)* Use of cortisone ointment (hydrocortisone)
* Antihistamines for hay fever (Aeries) * Medicines to prevent vomiting * Antacids: Maalox, Gaviscon and Antagel (alumina) * Iron for anemia (or ferogradumet ferrofumeraat) * Iron injection during pregnancy * Vaginal Tablets for fungal infection: Canesten (dotrimazol) * Injections for lung maturation: Celestone (bètametason) Contractions D Inhibitors (= Prepare ritodrinehydrochlorine, nefedipine) * Highly emotional events sometimes sedative drugs * Alcohol * Smoking * Vinyl in the bedroom or other rooms in the house * Cooking in aluminum pans * Frequent travel by plane (or work as a flight attendant or pilot) * High usage of mobile phones * Wireless antenna (WiFi) wireless internet at home. Medication during childbirth
* Medicine to induce contractions (oxytocin-Pitosin) * Pain Medication * Narcotics * Soothing medication * Sleep Medication Major health of me during my first two years and my mother during breast-feeding:
Nome principio attivo: LEVODROPROPIZINA SOP, medicinale non soggetto a prescrizione medica, per le formulazioni in sciroppo; RR, farmaco soggetto a prescrizione medica, con ricetta ripetibile, per le gocce. Farmaco di classe A31, a totale carico del Servizio Sanitario Nazionale con nota 31 (Classe A: limitatamente all’indicazione: “Tosse nella tubercolosi polmonare attiva e nelle neop
Bodies and Minds in Yoga: a response to Yoga Body A new book has just come out into the crowded yoga marketplace: Yoga Body by Mark Singleton. Unlike so many of the other yoga products this is neither full of glossy photographs (though the front cover picture is quite cute) nor making any particular promises. Instead this is a book that seeks to question some of the assumptions underlying