Scribd Logo
Upload

Welcome to Scribd!

  • City of Calamba Birthing Facility: Urinalysis Urinalysis

    Uploaded by

    Liecel Valdez
    9 views2 pages
    prenatal

    Original Title

    Pre Natal Form

    Copyright

    © © All Rights Reserved

    Available Formats

    XLSX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    prenatal

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    9 views2 pages

    City of Calamba Birthing Facility: Urinalysis Urinalysis

    Uploaded by

    Liecel Valdez
    prenatal

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 2

    LMP: _____/______/______EDC: _____/______/______ LMP: _____/______/______EDC: _____/______/______

    Date:_______________Accomplished by:__________________Date:_______________Accomplished by:__________________


    AOG: Difficulty in Urination AOG: Difficulty in Urination
    CC: Vaginal Infection: CC: Vaginal Infection:
    Weight: Discharge:__________ Weight: Discharge:______________
    BP:____________PR:__________ Smell:______________ BP:____________PR:__________ Smell:__________________
    RR:____________T:___________ Vaginal Bleeding: Y_____N RR:____________T:___________ Vaginal Bleeding: Y_____N____
    Fundic Height: LABORATORY TESTS Fundic Height: LABORATORY TESTS
    Presentation:_______________ Hemoglobin Presentation:_______________ Hemoglobin
    FHB:________Location________ HbsAg FHB:________Location________ HbsAg
    EDEMA:___Face _____ RPR EDEMA:___Face _____ RPR
    Feet:_____ Urinalysis Feet:_____ Urinalysis
    Conjunctiva/Palms: ( )pinkish ( )pale Conjunctiva/Palms: ( )pinkish ( )pale
    PLAN/INTERVENTION: PLAN/INTERVENTION:
    Date:_______________Accomplished by:__________________Date:_______________Accomplished by:__________________
    AOG: Difficulty in Urination AOG: Difficulty in Urination
    CC: Vaginal Infection: CC: Vaginal Infection:
    Weight: Discharge:__________ Weight: Discharge:______________

    City of Calamba
    BP:____________PR:__________ Smell:______________ BP:____________PR:__________ Smell:__________________
    RR:____________T:___________ Vaginal Bleeding: Y_____N RR:____________T:___________ Vaginal Bleeding: Y_____N____
    Fundic Height: LABORATORY TESTS Fundic Height: LABORATORY TESTS
    Presentation:_______________ Hemoglobin Presentation:_______________ Hemoglobin

    Birthing Facility
    FHB:________Location________ HbsAg FHB:________Location________ HbsAg
    EDEMA:___Face _____ RPR EDEMA:___Face _____ RPR
    Feet:_____ Urinalysis Feet:_____ Urinalysis
    Conjunctiva/Palms: ( )pinkish ( )pale Conjunctiva/Palms: ( )pinkish ( )pale
    PLAN/INTERVENTION: PLAN/INTERVENTION:
    Date:_______________Accomplished by:__________________Date:_______________Accomplished by:__________________
    AOG: Difficulty in Urination AOG: Difficulty in Urination
    CC: Vaginal Infection: CC: Vaginal Infection:
    Weight: Discharge:__________ Weight: Discharge:______________
    BP:____________PR:__________ Smell:______________ BP:____________PR:__________ Smell:__________________
    RR:____________T:___________ Vaginal Bleeding: Y_____N RR:____________T:___________ Vaginal Bleeding: Y_____N___
    Fundic Height: LABORATORY TESTS Fundic Height: LABORATORY TESTS
    Presentation:_______________ Hemoglobin Presentation:_______________ Hemoglobin
    FHB:________Location________ HbsAg FHB:________Location________ HbsAg
    EDEMA:___Face _____ RPR EDEMA:___Face _____ RPR
    Feet:_____ Urinalysis Feet:_____ Urinalysis
    Conjunctiva/Palms: ( )pinkish ( )pale Conjunctiva/Palms: ( )pinkish ( )pale
    PLAN/INTERVENTION: PLAN/INTERVENTION:
    Date:_______________Accomplished by:__________________Date:_______________Accomplished by:__________________
    AOG: Difficulty in Urination AOG: Difficulty in Urination
    CC: Vaginal Infection: CC: Vaginal Infection:
    Weight: Discharge:__________ Weight: Discharge:______________
    BP:____________PR:__________ Smell:______________ BP:____________PR:__________ Smell:__________________
    RR:____________T:___________ Vaginal Bleeding: Y_____N RR:____________T:___________ Vaginal Bleeding: Y_____N___
    Fundic Height: LABORATORY TESTS Fundic Height: LABORATORY TESTS
    Presentation:_______________ Hemoglobin Presentation:_______________ Hemoglobin
    FHB:________Location________ HbsAg FHB:________Location________ HbsAg
    EDEMA:___Face _____ RPR EDEMA:___Face _____ RPR
    Feet:_____ Urinalysis Feet:_____ Urinalysis
    Conjunctiva/Palms: ( )pinkish ( )pale Conjunctiva/Palms: ( )pinkish ( )pale
    PLAN/INTERVENTION: PLAN/INTERVENTION:

    You might also like