New Beginnings | NB1-Office

Patient Name: Adriel

Patient Information:

Patient ID: 9940

Patient First Name: Adriel

Patient Date of Birth: 09-03-2025

Gender: male

Assigned Office: NB1 east side

Primary Care Physician: Patricia, Azarcon Samonte

Patient Status: Active

Primary Attendance / Assigned Therapists:

ST - Speech Therapy:

FD - Feeding Therapy: Vera, Katelyn

OT - Occupational Therapy:

PT - Physical Therapy:

Patient Primary Authorizations:

Auth. ID	Status	Start Date	End Date	Insurance	ST-Units	FD-Units	OT-Units	PT-Units
23567	Active	03-16-2026	09-11-2026	Molina Healthcare	0	26	0	0

Speech and Language Soap Note/Visit:

ID	Soap Note

Feeding Therapy Evaluation:

ID	Date	Type	Evaluation Diagnosis
26292	02-18-2026	Feeding Initial Evaluation	R13.11, R63.39
Feeding Background History: Adriel is a 5-month-old male who was referred by his pediatrician for a clinical feeding evaluation due to feeding difficulties. Adriel’s mother served as the informant for the evaluation. Adriel’s mother reported that she had a full-term pregnancy with no complications during pregnancy or birth. Adriel’s mother reported that he underwent a lingual and labial frenectomy at StarKids dental in November 2025 due to a poor latch while feeding. She reported that Adriel’s latch significantly improved following the frenectomy. Adriel’s mother reported that she has been exclusively breastfeeding since he was approximately a month and a half. She reported feeding difficulties began approximately 3 months ago stating that Adriel does not “attend” to feedings as he used to. She reported that he now requires to be in a dark and quiet environment free from any distractions. She also reported that feedings have been shorter resulting in more frequent feedings. Adriel’s mother exclusively breastfeeds, however, is open to introducing bottles if it will result in more efficient feedings for Adriel. Adriel’s mother reported that she has attempted to try offering bottles such as Dr. Browns, Philips Avent, nuk, and Tommee Tippee, however, reported no success. Additionally, she reported that Adriel does not accept a pacifier.
Feeding Medical History: Adriel’s mother reported that he underwent a lingual and labial frenectomy at StarKids dental in November 2025 due to a poor latch while feeding.
Feeding Medications: None at this time
Feeding Behavioral Observations:
Feeding Communication Strengths:
Feeding Communication Weaknesses:
Feeding Background Summary:
Feeding Diagnosis/Impressions: A clinical feeding evaluation revealed moderate feeding difficulties and oral dysphagia characterized by limited tongue strength, coordination, and/or mobility. This negatively affects breastfeeding efficiency, potentially resulting in a shallow latch and fatigue during feedings. Feeding therapy is to target improving tongue strength and mobility and enhancing sucking coordination in order to optimize oral motor skills, latch, and increase endurance during feeds. Additionally, given Adriel’s age there is a likeliness that he will begin transitioning to solids during the proposed treatment authorization. Feeding therapy will also target transitioning from breast to bottle (per mother request) and introducing purees when Adriel demonstrates readiness and is cleared by his pediatrician if oral motor skill concerns persist.
Feeding Recommendations: Feeding Therapy: 1 time(s) a Week for 30 to 45 minute sessions

Feeding Therapy Plan of Care:

Plan of Care

58495

Plan Date: 02-18-2026

Feeding Assessment Summary: A clinical feeding evaluation revealed moderate feeding difficulties and oral dysphagia characterized by limited tongue strength, coordination, and/or mobility. This negatively affects breastfeeding efficiency, potentially resulting in a shallow latch and fatigue during feedings. Feeding therapy is to target improving tongue strength and mobility and enhancing sucking coordination in order to optimize oral motor skills, latch, and increase endurance during feeds. Additionally, given Adriel’s age there is a likeliness that he will begin transitioning to solids during the proposed treatment authorization. Feeding therapy will also target transitioning from breast to bottle (per mother request) and introducing purees when Adriel demonstrates readiness and is cleared by his pediatrician if oral motor skill concerns persist.

Feeding Rehabilitation Potential: Rehabilitation potential is good with consistent feeding therapy and parental support. Adriel will be discharged from feeding therapy when he demonstrates adequate tongue strength, mobility, and sucking coordination to allow for appropriate feeding skills.

Feeding Long Term Goals:

Category	Goal Description
Feeding/Swallowing	In 6 months time, Adriel will sustain an effective suck effort with a deep latch maintaining coordinated SSB pattern during breastfeeding and/or bottle feeding in 4/5 opportunities in order to support efficient and fatigue-free feeding.

Feeding Short Term Goals:

Category	Goal Description
Home Management Intervention Program	When counseled by the clinician, parents will incorporate the home management intervention program as a daily and weekly activity to transfer skills learned in therapy into the home environment. Home management training will optimize patient's feeding tasks in the home.
Feeding/Swallowing	In 6 months, Adriel will complete lingual oral motor exercises to improve strength and coordination for breast/bottle feeding in 4/5 opportunities to improve and strengthen oral musculature for functional suck pattern.
Feeding/Swallowing	In 6 months time, Adriel will demonstrate improved tongue cupping, elevation, and lateralization in 4/5 opportunities to improve and strengthen oral musculature for functional suck pattern.
Feeding/Swallowing	Within 6 months, Adriel will initiate and sustain an effective suck effort while maintaining a deep latch during breastfeeding and/or bottle feedings in 4/5 opportunities in order to improve feeding efficiency.
Feeding/Swallowing	In 6 months time, Adriel will safely and efficiently transition from breast/bottle feeding to age/skill-appropriate solids (when cleared by pediatrician) in 2/5 opportunities in order to support adequate nutrition and oral motor development.

Feeding Therapy Soap Note/Visit:

Soap Note

490559

Note Date: 03-19-2026

Subjective: Patient was friendly and cooperative,

Assessment of Goals/Response to Treatment: BASELINE When counseled by the clinician, parents will incorporate the home management intervention program as a daily and weekly activity to transfer skills learned in therapy into the home environment. Home management training will optimize patient's feeding tasks in the home. Mother was present for session. Goals targeted were discussed with mother. Questions were answered and clarified regarding feeding/oral motor exercises. In 6 months, Adriel will complete lingual oral motor exercises to improve strength and coordination for breast/bottle feeding in 4/5 opportunities to improve and strengthen oral musculature for functional suck pattern. Pt completed lingual oral motor exercises to improve strength and coordination for breast/bottle feeding in 2/5 opportunities. In 6 months time, Adriel will demonstrate improved tongue cupping, elevation, and lateralization in 4/5 opportunities to improve and strengthen oral musculature for functional suck pattern. Pt demonstrated improved tongue cupping, elevation, and lateralization in 0/5 opportunities Within 6 months, Adriel will initiate and sustain an effective suck effort while maintaining a deep latch during breastfeeding and/or bottle feedings in 4/5 opportunities in order to improve feeding efficiency. Pt initiated and sustained an effective suck effort while maintaining a deep latch during breastfeeding in 2/5 opportunities In 6 months time, Adriel will safely and efficiently transition from breast/bottle feeding to age/skill-appropriate solids (when cleared by pediatrician) in 2/5 opportunities in order to support adequate nutrition and oral motor development. Not targeted in session; mother reported that pt's pediatrician has cleared pt for trialing solids and pt is doing "well". Breastfeeding is primary concern at this time.

Plans: Continue with current Plan of Care,

Additional Notes: Mother reported that pediatrician does not have any concerns regarding weight at this time. Pt has a pediatrician appointment today and mother will update therapist regarding weight. Mother reported that pt's pediatrician has cleared pt for trialing solids. While breastfeeding during today's visit, pt did not immediately latch and initiate suck. Pt fed on right breast 2 times, took a break (distracted by sounds) and then proceeded to feed on left breast for a longer duration.

Completed Appointments:

ID	Plan of Care

Appt-ID	Service	Start-Date	End-Date	Therapist	Location	Status
891552	92610: Feeding Evaluation	02-18-2026 02:00 PM	02-18-2026 03:00 PM	Katelyn Vera	NB1 east side	Completed
908781	92526: Feeding Visit	03-19-2026 11:45 AM	03-19-2026 12:15 PM	Katelyn Vera	NB1 east side	Completed

Canceled Appointments:

Appt-ID	Service	Start-Date	End-Date	Therapist	Location	Status
908782	92526: Feeding Visit	03-26-2026 11:45 AM	03-26-2026 12:15 PM	Katelyn Vera	NB1 east side	Canceled

Scheduled Appointments:

Appt-ID	Service	Start-Date	End-Date	Therapist	Location	Status
914491	92526: Feeding Visit	03-30-2026 02:00 PM	03-30-2026 02:30 PM	Katelyn Vera	NB1 east side	Scheduled
908783	92526: Feeding Visit	04-02-2026 11:45 AM	04-02-2026 12:15 PM	Katelyn Vera	NB1 east side	Scheduled
908784	92526: Feeding Visit	04-09-2026 11:45 AM	04-09-2026 12:15 PM	Katelyn Vera	NB1 east side	Scheduled
908785	92526: Feeding Visit	04-16-2026 11:45 AM	04-16-2026 12:15 PM	Katelyn Vera	NB1 east side	Scheduled
908786	92526: Feeding Visit	04-23-2026 11:45 AM	04-23-2026 12:15 PM	Katelyn Vera	NB1 east side	Scheduled
908787	92526: Feeding Visit	04-30-2026 11:45 AM	04-30-2026 12:15 PM	Katelyn Vera	NB1 east side	Scheduled
908788	92526: Feeding Visit	05-07-2026 11:45 AM	05-07-2026 12:15 PM	Katelyn Vera	NB1 east side	Scheduled
908789	92526: Feeding Visit	05-14-2026 11:45 AM	05-14-2026 12:15 PM	Katelyn Vera	NB1 east side	Scheduled
908790	92526: Feeding Visit	05-21-2026 11:45 AM	05-21-2026 12:15 PM	Katelyn Vera	NB1 east side	Scheduled
908791	92526: Feeding Visit	05-28-2026 11:45 AM	05-28-2026 12:15 PM	Katelyn Vera	NB1 east side	Scheduled
908792	92526: Feeding Visit	06-04-2026 11:45 AM	06-04-2026 12:15 PM	Katelyn Vera	NB1 east side	Scheduled
908793	92526: Feeding Visit	06-11-2026 11:45 AM	06-11-2026 12:15 PM	Katelyn Vera	NB1 east side	Scheduled
908794	92526: Feeding Visit	06-18-2026 11:45 AM	06-18-2026 12:15 PM	Katelyn Vera	NB1 east side	Scheduled
908795	92526: Feeding Visit	06-25-2026 11:45 AM	06-25-2026 12:15 PM	Katelyn Vera	NB1 east side	Scheduled
908796	92526: Feeding Visit	07-02-2026 11:45 AM	07-02-2026 12:15 PM	Katelyn Vera	NB1 east side	Scheduled
908797	92526: Feeding Visit	07-09-2026 11:45 AM	07-09-2026 12:15 PM	Katelyn Vera	NB1 east side	Scheduled
908798	92526: Feeding Visit	07-16-2026 11:45 AM	07-16-2026 12:15 PM	Katelyn Vera	NB1 east side	Scheduled
908799	92526: Feeding Visit	07-23-2026 11:45 AM	07-23-2026 12:15 PM	Katelyn Vera	NB1 east side	Scheduled
908800	92526: Feeding Visit	07-30-2026 11:45 AM	07-30-2026 12:15 PM	Katelyn Vera	NB1 east side	Scheduled
908801	92526: Feeding Visit	08-06-2026 11:45 AM	08-06-2026 12:15 PM	Katelyn Vera	NB1 east side	Scheduled
908802	92526: Feeding Visit	08-13-2026 11:45 AM	08-13-2026 12:15 PM	Katelyn Vera	NB1 east side	Scheduled
908803	92526: Feeding Visit	08-20-2026 11:45 AM	08-20-2026 12:15 PM	Katelyn Vera	NB1 east side	Scheduled
908804	92526: Feeding Visit	08-27-2026 11:45 AM	08-27-2026 12:15 PM	Katelyn Vera	NB1 east side	Scheduled
908805	92526: Feeding Visit	09-03-2026 11:45 AM	09-03-2026 12:15 PM	Katelyn Vera	NB1 east side	Scheduled
908806	92526: Feeding Visit	09-10-2026 11:45 AM	09-10-2026 12:15 PM	Katelyn Vera	NB1 east side	Scheduled

Paient Notes:

Date	Posted By	Description
03-13-2026	Shekinah Velasquez	FD auth approved starting 03/16/2026 - 09/11/2026 1x/ week = 26 visits. Therapist assigned and notified.
03-10-2026	Shekinah Velasquez	FD auth request submitted to Molina. Pending approval.
02-25-2026	Shekinah Velasquez	FD IE paperwork sent to PCP via fax. Pending signatures and THsteps.

Paient Missed Visit Notes:

Date	Service	Therapist	Description
03-26-2026	92526	Vera, Katelyn	Adriel Franco-Ramirez 03-26-2026 11:57 AM Adriel (Prim) Replied: Hello Katie I'm so sorry we were on our way and got a flat tire ***Make up visit scheduled for 3/30/26.

Paient Messages Admin:

Date	Posted By	Message
01-21-2026 02:27 PM	Avery Fontenot	Please fillout the form https://patient.newbeginnings-elp.com/Registration/default.aspx?sid=2559
01-23-2026 04:07 PM	Avery Fontenot	Patient Registration: When you are ready to pick up where you left off, click this link https://patient.newbeginnings-elp.com/Registration/step2.aspx?sid=2559
01-23-2026 04:15 PM	Avery Fontenot	Patient Registration: When you are ready to pick up where you left off, click this link https://patient.newbeginnings-elp.com/Registration/step3.aspx?sid=2559
01-23-2026 04:57 PM	Shekinah Velasquez	Adriel has been added to our Feeding Therapy wait list. To send us a message at any time, just respond here. To check the status of the wait list, click this link https://patient.newbeginnings-elp.com/Schedule/waitlist_status.aspx?pid=9940&type=2&wid=525
01-28-2026 01:06 PM	Julie Mora	Hello, please email a copy of the Molina Healthcare card to jmora@newbeginnings-elp.com. Thank you
02-03-2026 03:51 PM	Caleb Tullius	🌟 You’re Invited! 🌟 Join us as we celebrate the unveiling of the Sensory Nook we proudly donated to the library! Come see the space, explore, and enjoy this special moment with us. 📅 February 7th, 2026 ⏰ 4:30 PM 📍 Esperanza Acosta Moreno Public Library We’d love to see you there! 💙 🌟 ¡Están invitados! 🌟 Acompáñenos a celebrar la inauguración del Rincón Sensorial que con orgullo donamos a la biblioteca. Vengan a conocer el espacio y compartir este momento especial con nosotros. 📅 7 de febrero de 2026 ⏰ 4:30 p.m. 📍 Biblioteca Pública Esperanza Acosta Moreno ¡Esperamos verlos! 💙
02-03-2026 04:54 PM	Julie Mora	Hello, this is Julie from New Beginnings front office. I called your child's PCP to request the Feeding DX code that we are pending. The front office said they fax the new referral as soon as the Dr provides them with the correct code. Also, I wanted to ask if you were able to get the Molina insurance card? If so, would you be able to email a copy to jmora@newbeginnings-elp.com Thank you :)
02-03-2026 05:44 PM	Adriel Franco-Ramirez	Perfect thank you
02-04-2026 02:14 PM	Julie Mora	Hello, I wanted to give you an update. We received the new referral from Adriel's PCP. We are only pending the copy of the Molina insurance card. The card that was uploaded is the Texas Medicaid card. Unfortunately, we can not accept that card we need the Molina card. If you have any questions please give us a call at 915-855-0601.
02-04-2026 02:17 PM	Adriel Franco-Ramirez	Okay thank you let me get that card to you
02-12-2026 12:15 PM	Julie Mora	Hello, I wanted to check in with you to ask if were able to get Adriel's Molina Health insurance card. As soon as we receive the card, we will be able to schedule Adriel for an initial evaluation. You can email a copy of the card to jmora@newbeginnings-elp.com. Thank you
02-12-2026 03:24 PM	Adriel Franco-Ramirez	Ok perfect going to send it now
02-16-2026 05:28 PM	Caleb Tullius	Join us this Wednesday!
02-16-2026 05:49 PM	Stephen Tullius	Please join us for the next New Beginnings free Parent Training: Introduction to AAC (Augmentative and Alternative Communication). This session introduces AAC in a simple, supportive way on why it's used and how it helps children communicate. Register here: https://patient.newbeginnings-elp.com/trainings/default.aspx?id=19&pid=9940
02-18-2026 04:16 PM	Stephen Tullius	For those of you that would like to attend our parent training: Introduction to AAC, but are not able to attend in person, we are setting up a webinar. This will be our first attempt at a webinar so I hope it goes well :) Here is the link: https://webinar.getresponse.com/JvvC9/introduction-to-aac/
03-09-2026 07:22 PM	Stephen Tullius	Please join us for the next New Beginnings free Parent Training: Sensory Play. In this session learn how to create safe, engaging sensory experiences that help hypersensitive children regulate their responses to touch, sound, and movement. Register here: https://patient.newbeginnings-elp.com/trainings/default.aspx?id=20&pid=9940
03-11-2026 05:40 PM	Stephen Tullius	Hello, for anybody who would like to attend our Sensory Play parent training today but can't, we will be attempting a webinar version. You can register to see it online at https://webinar.getresponse.com/JvvC9/sensory-play/
03-13-2026 03:27 PM	Shekinah Velasquez	Hi, Adriel as been assigned a therapist for Feeding therapy. Here's a link to learn more about Katelyn https://st-pros.com/newbeginnings/reports/welcomefromtherapist.aspx?id=9940&tid=51
03-13-2026 06:00 PM	Adriel Franco-Ramirez	👍

Paient Messages Therapist:

Date	Posted By	Message
02-16-2026 12:53 PM	Katelyn Vera	Good Afternoon, this is Katie from new Beginnings. I am the speech language pathologist that will be completing Adriel's feeding evaluation. Please let me know when you are free for a call so I can gather some information before the evaluation on Wednesday.
02-16-2026 12:58 PM	Adriel Franco-Ramirez	Adriel (Prim) Replied: Hello I am available today at 2
02-16-2026 03:15 PM	Katelyn Vera	I apologize, I was with a patient. Are you free now?
02-16-2026 03:21 PM	Adriel Franco-Ramirez	Adriel (Prim) Replied: Yes
02-17-2026 06:30 PM	Katelyn Vera	Hi, this is a just a reminder that Adriel has a Feeding Evaluation appointment scheduled tomorrow at 02:00 PM. See you soon! - New Beginnings 🙂
02-18-2026 07:57 AM	Katelyn Vera	Hi, this is a just a reminder that Adriel has a Feeding Evaluation appointment scheduled today at 02:00 PM. See you soon! - New Beginnings 🙂
02-18-2026 01:45 PM	Katelyn Vera	Adriel Franco-Ramirez : Time to check in at New Beginnings 🙂 Click here https://patient.newbeginnings-elp.com/checkin/default.aspx?AppId=891552
03-15-2026 12:44 PM	Katelyn Vera	Hello, this is Katie from New beginnings. I hope all is well. We received the authorization to begin feeding therapy this week. I can schedule for Thursday at 11:45am if that works for you :)
03-16-2026 09:34 AM	Katelyn Vera	Good Morning, this is Katie from New Beginnings. I just wanted to follow up to see if you received my message yesterday about beginning feeding therapy this week.
03-16-2026 09:41 AM	Adriel Franco-Ramirez	Adriel (Prim) Replied: Yes Thursday at 1145 works!
03-16-2026 01:50 PM	Katelyn Vera	Okay, I’ll see you guys on Thursday!
03-18-2026 06:30 PM	Katelyn Vera	Hi, this is a just a reminder that Adriel has a Feeding Therapy appointment scheduled tomorrow at 11:45 AM. See you soon! - New Beginnings 🙂
03-19-2026 08:01 AM	Katelyn Vera	Hi, this is a just a reminder that Adriel has a Feeding Therapy appointment scheduled today at 11:45 AM. See you soon! - New Beginnings 🙂
03-19-2026 11:30 AM	Katelyn Vera	Adriel Franco-Ramirez : Time to check in at New Beginnings 🙂 Click here https://patient.newbeginnings-elp.com/checkin/default.aspx?AppId=908781
03-22-2026 04:00 PM	Katelyn Vera	Hi, this is a just a reminder that Franco-Ramirez, Adriel has a Feeding Therapy appointment on 03-26-2026 at 11:45 AM. Reply YES to Confirm or NO to reschedule - New Beginnings 🙂
03-22-2026 04:21 PM	Adriel Franco-Ramirez	Adriel (Prim) Replied: Yes
03-22-2026 04:21 PM	Katelyn Vera	Hi, I received your message but am not at work at the moment. Please be patient and I will respond just as soon as I can. Thank you for understanding! 😊 -- This is an automated message.
03-25-2026 06:30 PM	Katelyn Vera	Hi, this is a just a reminder that Adriel has a Feeding Therapy appointment scheduled tomorrow at 11:45 AM. See you soon! - New Beginnings 🙂
03-26-2026 07:56 AM	Katelyn Vera	Hi, this is a just a reminder that Adriel has a Feeding Therapy appointment scheduled today at 11:45 AM. See you soon! - New Beginnings 🙂
03-26-2026 11:30 AM	Katelyn Vera	Adriel Franco-Ramirez : Time to check in at New Beginnings 🙂 Click here https://patient.newbeginnings-elp.com/checkin/default.aspx?AppId=908782
03-26-2026 11:53 AM	Adriel Franco-Ramirez	Adriel is RUNNING LATE for: 11:45AM-3/26/2026 92526: Feeding Visit
03-26-2026 11:56 AM	Katelyn Vera	Hello, what is your estimated time of arrival?
03-26-2026 11:57 AM	Adriel Franco-Ramirez	Adriel (Prim) Replied: Hello Katie I'm so sorry we were on our way and got a flat tire
03-26-2026 12:00 PM	Katelyn Vera	Hello, I am sorry to hear that! I can reschedule for later today at 1pm or Monday if that works out better for you.
03-26-2026 12:06 PM	Adriel Franco-Ramirez	Adriel (Prim) Replied: Monday is perfect
03-26-2026 12:29 PM	Katelyn Vera	Okay I can schedule for Monday at 2:00pm :)
03-26-2026 01:08 PM	Katelyn Vera	Katelyn Vera CANCELLED: 11:45AM-3/26/2026 92526: Feeding Visit
03-26-2026 02:06 PM	Adriel Franco-Ramirez	Adriel (Prim) Replied: Ok yes Monday