My Doctor Online The Permanente Medical Group
Are you having back pain with any of the following?
- Severe pain, weakness or tingling in your leg(s).
- Difficulty stopping urination or loss of control of bladder or bowels.
- Unexplained fever, nausea or vomiting.
- A history of cancer or unexplained weight loss.
We understand that you are experiencing one or more of the health issues that might be impacting your back pain.
We recommend that you discuss these health issues with your doctor before proceeding with this program.
Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.
Shannon Udovic-Constant, MD
Pediatrics
Welcome to my homepage, a website developed to make it simpler for you to take care of many of your healthcare needs. As your pediatrician, I believe that maintaining a good relationship means being able to easily communicate with one another. This website allows you to email me, check your lab results and immunization record, make an appointment, refill prescriptions, and more! I look forward to sharing in the care of you and your family.
Quick Links
- Department Favorite Handouts
- Cold, Flu and Cough
- Online Newsletters for Parents
- How to Manage Your Child's Care Online
- Breastfeeding Your Baby: Department Favorite Handouts
- Anatomical Charts
- Sport Injury Prevention
- ACL Injury Prevention
- Car Seat Safety for Children
- HealthyChildren.org (AAP)
- Pediatric Acetaminophen (Tylenol) and Ibuprofen (Advil, Motrin)
- Prepare for Your Procedure - Emmi
- Recommended Immunization Schedule
- Vaccine Information Statements
- Young Adult Health
General References
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Forms
Well Check Questionnaires
Age specific health questionnaires for parents to print out, fill in, and bring to your next well visit. English with Spanish on reverse.
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Birth to 1 Year
- Health questionnaires for parents of infants to print and fill out before each routine well baby visit.
- 2 to 4 Week Health Questionnaire
- 2 Month Health Questionnaire
- 4 Month Health Questionnaire
- 6 Month Health Questionnaire
- 9 Month Health Questionnaire
- 12 Month Health Questionnaire
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1 to 12 Years
- Forms for parents of children ages 1 to 12 years to print and fill out before each well visit.
- 18 Month Health Questionnaire
- 21 to 24 Month Health Questionnaire
- 3 Year Health Questionnaire
- 4 to 5 Year Health Questionnaire
- 5 to 6 Year Health Questionnaire
- 6 to 8 Year Health Questionnaire
- 8 to 10 Year Health Questionnaire
- 10 to 12 Year Health Questionnaire
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12 to 18 Years
- Forms for parents of teens and teens themselves to print and complete before well visits.
- Parent of Teen Health Questionnaire
- Teen Health Questionnaire
- Athletic Screening Exam
Developmental Assessment Forms
Forms parents may be asked to complete as part of a developmental evaluation. Complete as directed.
Health Exam for School or Camp Entry
Standard state form documenting well visits and immunizations. Often required for school, sports, or camp entry.
- San Francisco Unified School District – School Health Form 2011/2012
- Proof of Health Exam and Immunizations for School Entry
- San Francisco Unified School District Medication Form for Albuterol use
- San Francisco Unified School District Medication Form (generic)
- San Francisco Unified School District Pre-Participation Physical Evaluation Form
- Athletic Screening Exam
- Emergency Care Plan (English)
- Emergency Care Plan (ESPANOL)
- Emergency Care Plan (Chinese)
Asthma Forms
Tools to help manage your child's asthma
- Asthma Action Plan
- Asthma Puff Count Card
- 2 Week Asthma Diary
- San Francisco Unified School District Medication Form for Albuterol use
- Asthma Control Test (ACT) - 4-11 years
- Asthma Control Test (ACT) - 4-11 years (Spanish/Español)
- Asthma Control Test (ACT) 12 years and up
- Asthma Control Test (ACT) 12 years and up (Spanish/Español)
Other Forms
Forms that must be filled out for children to be referred to services outside of the pediatrics department.
Consent Forms
Forms that parents or guardians can fill out to give consent for immunizations, treatment, and/or release of medical records.