(Attic identification label here) Pregnancy en ; tem | Health Record frre mite Given name(s). MING a Clinician's section Aacess: The 4tund Valonta Attach ADR Sticker Medare number: 2LtALG Date ofbien:14 - December - 437 “ALLERGIES AN AOVERSE DRUG REACTIONS (AOR CnticewnUnnom a soviet ers ebm) Model of pe srone) Traag| |] Medicare Ineligible - Comments Reason for model of care: Religious, ethnic or cultural considerations Important fo antenatal | Jeare (0.9. blood products, citar, te): Sen os Dae | PRIVACY STATEMENT: As part of the heallh service provided to you, Queensland Health collects identifying information about you hat is Known | eet rn cane arn Ses ier oope ecko wr taian as fo eee oa aE eT | eer era ann ey A ad enamels De oe ea ea rm {nformaton wil be securely siored and only sevessile by authorised staf at Queensland Health. The information included i yout Pregrarcy Heat | Ree er oa et era oer ayonnetiearrae| Sarge rnc navies oti Goce hn ary Ta aerate eoaeeare| Feet tte dee heel int era MEnmneinnicn) Preferred name: Age: | Marital status: } Kare eS pace pantry of bit 7 Austaia (other: you of Aboriginal or Tortes Sal slander origin? (Sth bores may Bo Skea) aja of Tat antenatal vat Res Aboriginal es, Torres Sta slander a 10! 0x0 Do yer hioe ony pcblone cans Engl and undrlncing te cone of Wis regancy Heath Resor? Te ee ‘Occupation: | | Teocher _ 2 —— _ es Coe eS @ karate 667 .com a +6lY 2 34s 676 Biological Father of the Baby's Information Preteres name: eee rae enue? hosvala Other: ‘Yes, language: ‘pxe/ou of Aboriginal or Torres Strait Islander origin? (both boxes may be ticked) oot es, Torres Stat Islander __]NO im number aa a Email address: FEIY S4B 72819 GEthes123.com rR e Details of smoking / alcohol use: bo Not _smo Fe maleriy caro [ee cu Prey nan JL idwie carta_peart Mat No. 10178298, Namo ‘ aos 7 ‘the rand Parade 26h cax ina | a" @ caso pear ute -com ‘| Pere Fox Pager Prove {Fax Pager i ¥61421% 7a G18 | \ | [shared care:| Was {Ito | lOwconinved Shaved eww: (— You INo_{ 1Discontinued Pogo ni of 16(an 2 (ate entiation abe here) uew Family name: Kar Mite, Given name(s. Mila Address: The 9fand Valonta Medcare number: LOIS Dateorbitn: (9~(2 = (907 "To be completed by 8 medical officer (BMI: Use pre-prognancy woigh I known, otherwise use first weight faker [Breasts / Nipples: Dat Gf 10 / any) stand oye | Bookingin weight Pre-pegnancy weight Height Se | s\ ‘g s7 Ad 160 em gp bem Po Pre-pregnancy BML 19,5 ] Guserweiont st. Referral to Respiratory: N95 | Finrmai 185-249) medical officer oe Overweight (25-29) [_]Diettion for review 2.0% /pinube Clinically obese (230) — |Physio for review lordly obese (a | Aodominal BMI: iM a : 0) soteral weer gundat helgh ag em | Underweight 18.5) Referral to GE ho! DA OMI Nomal (18-249) _ medica offeer ‘Overweight (25-29 9) | Ditiianforreview | Skeet Ciinicaly obese (230), Physio for review Norenat _ Morbidly obese (240) |Cx (Pap) smear: - en) — —_—__—__—} [Uprtodate [Jotered v{Pertormad [| Deciined detente postpartum —» Referral arranged = i Dental a a = Last appointment: 12/10. 2022 Name iearmie - | Designation [Signature: Hee Pree Calculations assume a 0.5-24g weight gain inthe frat | Pre-pregnancy BMT trimester fr single babies | Rate of gain Ond and 3rd] Recommended total |] | trimester "gain range (kg) Refer to dietitian f multiple pregnancies, as different |goals required. Dietary and physical activity f a [esas requirements discussed (refer to page b2) |185 10249 045 [115016 Refer to Queensland Cinical Guideline: Obesity in = pregnancy for further information. 22 W282 zee - isi eB | 022 5109 “Anaesthetic review Neonatal / Paediatric review “Yes > Review date Cinta ver Revewane:/ | Cita = ZNo NIOUVN ONIONIG SIHL NI SLR LON O@INDING MARGIN: DO NoT WRITE IN THIS BI! ‘AntlD Prophylaxis {Not required {Rh D negative | women only) Batch number: ‘dTpa (diphtheria, tetanus and whooping cough) vaccine oe ii Yes Date given: [influenza vaccine ‘Other (specify) "Date given: Drees | Woman's principal model of care Public hospital maternity care [Midwifery group practice caseload care Team midwifery care = Public haspital high risk maternity care ™ Remote area maternity care C Shared care Cl2eweeks Ino, reason Gestation: mehssitenneaitiathtaasideas URN. ; Family name: FA tlle Given namels): Mle aaoress: the grand volorilc Medcare number: ROWS pate orbian: 14 Desember 1497 Print name Neamile Designation: | fulete | Print name: Keuamele Designaton Nula | Print name! Batch number: Designation: weeks tele Batch numbef: iI weeks || jatch number: weeks | sigan | mle Combined care General Practitioner obstetrician care rivate midwifery care = Private obstetrician (specialist) care (moder to: ~ Private obstetrician and privately practising midwife joint care | Kteunnita al "Signature: Signature: | Signature: Reason for model chosen: Name: reamite Change of model of care. ‘New model Reason for change of model of care: [Designations pinta To lenow the concern of the fetus anc mother Date agreed: Lot 19 14639 of change: oe) 2223Clinician’s section Tearmewn mils | Energy, breathe easier infetons +4 Cancers + LRisk of SI0S, asthma +} Gargiac / Respiratory disease 3] Education ‘fem posite change £ Give encouragement 7 Discuss support ~ GP, Quitine 13 QUIT (13 7648) a Discuss Nicotine Replacement Therapy (NRT) “B| Written resources given —Yes VUDeciined 4 2 Yes ViDectined ‘| Quitline referral completed Yes “Declined it yes. completed Quitline referral: health ald gov aulpublc-neath/opics/atod/quitine-hp-referal.form/defaul -§ Presse compete the folowing at every opportune vist for smokers and recent quits | __Visit date [Week gestation | Cigarettes per day ‘Advice offered | Support Assistance given) Initia QF 10 12 | 30 anaes - : : —Y : —_ Pe Page a15 of 16 onoas s,uel2iuttg |(2 entfcaton ibe! hers) URN: Famiyname: Karyna : Given name(a: Ne . cceess: Tht grand Valor Meseare umber FIN Date ofbinn: WY Dek inbe 847 Drug and Alcohol Screening Tool Drug screening: In the past 3-6 months have you used any prescribed, non-prescribed or herbal drugs? yes: + Specly + Reter to local support service for assessment and ongoing support cir Ask again: ‘Vat date 1: | Weeks gestation’ | Suppo / Assistance given [Wai date 2) | Weeke gostaton’| Suppon /Avwistance gen rt fan [Dates 7 ‘No alcohol in pregnancy is the safest option, please ask, you can make a difference Initial DURING THIS PREGNANCY || ‘Z| How often have you had a =| drink containing alcoho! init? ‘Only pior to confirmation of pregnancy; stopped at... [never (0) [712 to 3 times a week (3) Monthy or less (1) 7714 or more times a week (4) 71204 times @ month (2) weeks (0) Scoring Add ho scores (shown ia brackets) for ach ofthe three questions fora tote score out of 12 ow many standard rinks |E]1 0201) r9@) ote Mevevou bed ana pte Bases 40 or more (4) ero | day when arising? eee oO Newsham | 3. Same ih et How often have you had six ||_|Less than monthly (1) Weekly (3) e Reky dieting (Germresanerd ins" Daly or anos day 4) err araing | {Readiness to stop dining [An ‘Wow ready ar yout sop Wining now you are pregnant?= 3 \IWA.Notready "2. Unsure 3. Ready 14. Staying a noncrinker "]5. Relapse | barriers to stopping drinking |” |witnrawal/ Cravings Partner inking | JSvess \46ther cil Notes = Sn || Becarute pregnancy, - _ 2/ONo risk drinking 3] some risk arning §/14-5 Risky drinking * Gongratulate and reinforce no safe level of crinking whist pregnant + Reinforce thee is no cafe level of érnking whilst pregnant + May incieate harm for baby + Relnforce there is no safe level of drinking whilst pregnant | + May ingicate harm for baby + Reinforce benefits of stopping at any tine |-Diseuxspotntal elec ot curenGonking eels, incuding healt concerns for both | woman and baby | «Fetal Alcohol Spectrom Disorder (FASO) $user ready toc Gown or Stop: » ask how confident she is about succeeding *Sskif oho would ke some ansstance 7 1 ofr eter fo loesl suppor service 26 High-tsk drinking «Advise same as sky drinking’ section above + Refer local support service for assessment and suppor al {igeus concerns wih weating team Z| [Education 'VAlfiem positive change : Give encouragement & Dass suport ay, Gr, A008) B|Weitten resources given For woman: (Yes Visined 3 Forpartner: __ Yes V/oecines Retort Local Support Series: Fans (“Decne neo oon uate) ~ |indigenous Heath Clint: Faxed | [Decne (mide to flow un atroxtvit)_WINA ‘§ [Fosse compete te Flowing at even epportune vat 3] visi cate | Drinks] 2, Slage of eadinn 3, Advice otfered —] & Suppor /Asaistane® |i | Misitaste | gestation | ‘poruay | {as above in Assoss) ik’ of ering) idiven refer ene 6 17 |v wooly Oh G2 Gs G4 Os Weke blood jul Le eu 1 O2 Os Os Os 71 Ot Oe Os O4 Os at On C2 Lis Lis Ls £:s O1 G2 Ls Ls Us | Page at6 of 16 NIOMVW ONIONIG SIHLNI LIM LON oa.O NOT Wrire i THIS BINDING MARGIN t regency Om ee Health Record 27~™ Kamin ‘Government Given name(s): MWA , addess: The gran valonia Woman' Medicare number: 2 LUA a I's section J caro ty DesembUr typ > Always carry this record with you You must bring this record with you when you visit any health care professional / hospital. Please complete the following pages at home. acknowledge that: 1, [have read the disclaimer on page b8 of this document and have understood it ‘My Pregnancy Health Record (PHR) is not intended to replace the advice I receive from my treating health practitioners. My PHR is not intended to replace the need for me to provide informed consent to any treatment or procedure, 111 elect to carry my PHR. | accept ‘8 It will be my sole responsiblity to produce my copy of the PHR at all appointments and bith with all my treating he practitioners. | understand my record will be updated at each visi. », The safekooping of my PHR and the information contained in my PHR will be my sole responsibilty. For further information please refer to the About Pregnancy Health Record brochure. | | c, My PHR contains confidential heath information about myself as well as confidential information about the father of my chil. 4. It be my esponsibillyto advise the health care professional i woud ike to Keep some information private and ntl include | iin he PRR. ‘Iti be my responsibilty to ensur 2 3. 4 Shy that the PHR is updated at every visit to any health professional in Queensland Health, | will be my responsibilty to ensure that relevant information is included in my PHR at any appointment or during any episode | ‘of care from a non-Gueensiand Health health practioner 1 A photocopy of this document wil be Kept in my Hospital file, The orginal willbe retained by the hospital after the bith. | may then take the photocopy for my personal records, Tt woud ke to earry my PER Signature [would NOT lke to carry my PHR. Ge tas: | No —\CNe KL — — a | Gueensiond Health has a guideline tiled Establishing breastfeeding and your local bthing hospital has infant feeding information Jevailabl. Ask your midwife fora copy. Where relevant ths information vail outine the Ten Steps to Successful Breastfeeding and how your faciity meets each of these sleps in accordance with their Baby Friendly Health invative (BFH! status, [Sign and di itis discussed importance of Breast mik ie a complete f00d for your Baby. I's 8 living Auld constantly changing | lbreestfeeding for | according to your baby's needs and packed full of nutrients and antibodies to boost |G /10) /2% _your baby's immune system. - _ _ _ | Breastfeeding may assis the bonding and attachment between mothers 1 ‘and babies. Date | Initial + Breastfeeding promotes faster maternal recovery from childbirth and women who joe MO / 22 | have breasted have reduced risks of breast and ovarian cancers later in ife. + May assist mothers to lose weight ater baby’s bith. _ + Breastfeeding Is tre, safe, convenient and environmentally friendly. sstfeeding for _|+ No preparation required, ready anytime. anywhere. O61 (0124 Risks of nat + Ababy no breasfed ie more likely fo develop infectons. Type 2 diabetes, some Tf breasttending Chishood cancers, obesity, lower Id and higher Iketnood af sudaen infant death @B / [OV Az | __|__syndrome (S108 or cot death) _ — i dng ose afer birt Keeps babies warm and elm. Promates bonding early uninterrupted |- Babies can ear their mothers’ heartbeat shingorshin "|: Babys near and beating nomalaed 06 Fo Ina contact after birth. Necessary procedures and checks should wait until after the first feed. [fora babies y proce wa tl ater How to recognise |» When a baby has skinto-skn contact aftr tinh tere ar ne obserabe newborn when baby is ready | stages: hoppening ina spect ode tat ae insite forthe baby. thin oauach tothe. | eacheltnoce sages, ave ae vaely cf actons tebaby may demonsvate 06 / 10/2 Breast forthe rat_| Theve slages athe Brinn relanaon, aeakerng, civ rest. crowing. ie st | famonavon sacking sna ial wage eee [No other food or | WHO, UNICEF and NHMRC recommend: drink to around the |- Early intaton of breasteeding win 1 our of ith first €months |. Exclusive Ereasteedng to around 6 months of 290 |» Exclusively breastfed babies donot equ addtional ids upto 6 months of age | + Continue breastfeeding until 12 months of age and beyond while introducing | @ilory ‘complementary (Solid) foods at around 6 months of age. Fist foods need to Include onic foods, Optimal infant nutntion: Infant feeding Guidelines (NHMRC. 2012): i hos: eatforhealth gov aulstes/defaulvflesiiesthe quidelines!nS6p infant feeding summary 130608.pdf —_ ask for breastteeding help when you af starting out joffto.a good star_|- Posiioning applies to ensuring you hold baby close to you (chest to chest, tho babys beck wel supported, babys chin sf the breast with a wide open mouth. + Effective attachment is recognised by no significant nipple pain, baby's cheeks not. O98 Gown in and evicence of mk tensor suchas swatonng sounds + Babies are fed according toner needs in response to feeding eves / signs, a long land os offen a8 baby requires, | Having your baby’s cot beside your bed or in your roam means: t | rooming in rican cuss your aby whenever you want 1 Seto unow your baby belo you home | + Breasteed when your baby shows feeding signs ws taaa) 2 Lower tne incidence of jaundice _ Decreate tho chance of hospital acquredinfecton, ——_ | | Signs baby te “Anywhere from Bto 12 breastfeeds per day is normal whist breastieeding is | feeting enough |” beng estaished + 5106 wel nappes each day afer te frst 5 days « Abrentaa tay wt po a leas! 4 ies 8 day by the endo fst week and poo wil I. | |__| — Geting |» Breastedig problems are most fen caused by baby ot atoching | i 26 or | _be yellow and runny —__ “Page bare NOUV ONIONIG SIHL NI LISA LON O@0 NOT WRITE in ris BINOING MARGIN (Atacisoriteaton tibet here) URN Family name: Karma the, ven names) MALE: : Address: The- grand VOlonLa Medicare number: 30 14.6 Dato orbit LY - 1-19 g 2 ‘eeding Your Baby (contived) Formula feeding How your family land friends can [support you? [Where to get help and support in the ‘community Woman's signature: ay le [Sign and date each section as itis discussed ot Reduces ime atthe be st often resulting In a decrease in milk supply. | ‘an inappropriate sucking action + Decreased desire to feed at the breast + Using teats and dummies prior to 4 weeks of age can cause problems while Mum ‘and Baby eam tot ther baby. ‘Mothers who formula fe 7] 7¢ shown how to safely and appropriately feed ‘Cow's mik-based formula is sutable forthe frst 12 months of Ife uniess there are specie medical indications % + Cows / Goat / Almond / Rice / Sheep miki not: lable for babies under ‘2 months of age, a breast mik substitute formula should be used for this penos Check with your local maternity services regards bringing formula and feeding _ equipment requirements to hospital ‘Your partner, family and fiends can help ina iol of ways other than feeding (setting, Tit 10! 6 124 ‘baby massage and bathing). (& 10 '29 1S HEALTH (194925 84) provides neat information, feral and tltiane Services tthe pubicin al pars of Queensland forth costo fca cal. Calls trom mobile phones may be charged ata higher ae. For reasteeding and child heath advice ask fora chi heath mare, Achid health nurse is avaible 7 days 8 week For 0830 nour to 23 ooneus, + Queensland Hea breasveedng website st ttn eath a iat + International Board Certified Lactation Consultants in Private Practice. % No 12g + Onis Heat Service + General Practtoner + Australian Breastfeeding Association - 1800 mum 2 mum (1800 686 268) 224 hour helpline. + Raising Children Network at: ilpu/rasingchidren nel aubabies/babies hint ptt enna oral Date: 0 Thave had all the above information discusced with me and my questions answered to my salsfacion, No tae allied health: Page bs of 8 uog2es s,uewon(Atta idetcanon taal ner) Rw Famiy name: Kermt a Gwen nares) Alls . assess: TH Gond valonits Mesicare number Out Date otbith Uy [21947 1. Tare tablet te Increase bod 2 Adequate Nutrition | needs: 3. ehough Feit Leer Your seie clean C fecenad Hygiene) c. Mane 2 ( week Return visit song (ern SS Record Statewide Page b6 of 8 NIOMYW ONIONIS SIL NI ALIA LON O@Woman's section (Ata identcaton Inbe here) uRw Famiy name: eat matic, Gwen nameis): MULL, address: The Grand valonis ‘Medicare number: AOU pate ofbian: 19=(2~ (QQ7 ater kl siioe ied Useful Phone Numbers 13 HEALTH 134325 84 available Domestic Violence Hotline 1800 811 811 26 hous eee ek) Cnn Time Type of Appointment First GP antenatal care Pees ee L ‘Type of Appointment _ Where ——Booked] Hospual Yes it Hospitay ves cr 7 - Yes DISCLAIMER: Tht decomen vot ana chou ot bu Vaid an Gusenalod Henle complete alontal record fr the woman, Copies o [Queensland Heat's complet elena ecord may be mase avaiable to re womans teabng health pracitionets) on request. The infomation Included in wis document may incorporaie or summarise views or recommendations of ealhpraciboners. Such information does not necessary tele the vews of Queenan Heather indcale » commen 0 9 pordeus course acion.cudgments regarding cen management of he woman are mates frie appropiate heath prtessonaia) responsi ar cnc’ decison about pacu cic! pocedur} er Feevret Flons)-Ths document does ra consite eee ness Soe nin reacontoatypecesre pancs)-Ti cn informed consent rom the woman in relaton'o any procedure. Gueensiand lath makes no sistmerts repeaeriators cr warranies sbout ine Sezuracy. Sompstaness, tess for purpese or relly of ay loan contained ins document Gueensiana Health sigma, to the mum extent pared by am. a habity Cacesng, witout loner loots Pegigence) frat expenses losses damages and costs incuned (or any reason aesouitad wih the use of 0 relance on tog docnnam, een vere the infraton contained wihn'te'n any way maceuralew ineompits Page b8 of 8 MOUYH ONIONIG SIL NI SLIM LON og