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LAPORAN KASUS
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Tanggal
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Oleh :
 _________________________ 
NIM
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PROGRAM STUDI ILMU KEPERAWATANSEKOLAH TINGGI ILMU KESEHATAN HANG TUAH SURABAYATA. 2010/2011
 
LEMBAR PENGESAHAN
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Tanggal
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Oleh :
 _________________________ 
NIM
...............................Mengetahui,Penguji Pendidikan ______________________ Surabaya, ................ 20.....Penguji Lahan ______________________ 
 
FORMAT PENGKAJIAN POST PARTUM
UNIT KEPERAWATAN MATERNITAS
Tanggal masuk : ........................................Ruang/kelas : ........................................Pengkajian tanggal : ........................................Jam masuk : ........................................Kamar no. : ........................................Jam pengkajian : ........................................
I.IDENTITAS
 Nama pasien : ..................................Umur : ..................................Suku/bangsa : ..................................Agama : ..................................Pendidikan : ..................................Pekerjaan : ..................................Alamat : ..................................Status perkawinan : .................................. Nama suami : ..................................Umur : ..................................Suku/bangsa : ..................................Agama : ..................................Pendidikan : ..................................Pekerjaan : ..................................Alamat : ..................................
II.RIWAYAT KEPERAWATAN1.Riwayat ObstetriA.Riwayat Menstruasi
Menarche : umur .........................Banyaknya : ..................................HPHT : ..................................Siklus : teratur ( ) tidak ( )Lamanya : ..................................Keluhan : ..................................
B.Riwayat Kehamilan, Persalinan, Nifas Yang Lalu
Anak ke Kehamilan Persalinan Komplikasi nifas Anak 
 No. Tahun Umur kehamilan Penyulit Jenis Penolong Penyulit Laserasi Infeksi Perdarahan Jenis BB PJ
C.GenogramD.Post Partum Sekarang
Riwayat persalinan sekarang : ................................................................................................Tipe persalinan : Spontan/bantuan ..............................Lama persalinan:
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