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  • Pedia HOA Template

    Uploaded by

    Gebrelle Castillo
    7 views2 pages
    This document appears to be a medical record form for an obstetrics patient. It includes fields to document the patient's name, date, provider, gestational age, last menstrual period, estimated due date, vital signs, medications, chief complaint, history of present illness, past medical history, family history, and physical exam findings. It also includes calculations for various resuscitation medications doses based on the estimated fetal weight.

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    pedia HOA template

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    This document appears to be a medical record form for an obstetrics patient. It includes fields to document the patient's name, date, provider, gestational age, last menstrual period, estimated due date, vital signs, medications, chief complaint, history of present illness, past medical history, family history, and physical exam findings. It also includes calculations for various resuscitation medications doses based on the estimated fetal weight.

    Copyright:

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

    Pedia HOA Template

    Uploaded by

    Gebrelle Castillo
    This document appears to be a medical record form for an obstetrics patient. It includes fields to document the patient's name, date, provider, gestational age, last menstrual period, estimated due date, vital signs, medications, chief complaint, history of present illness, past medical history, family history, and physical exam findings. It also includes calculations for various resuscitation medications doses based on the estimated fetal weight.

    Copyright:

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

    Name:__________________ Date: ___________________

    OB:_______Pedia:________ Live, T / PT, NB


    __y/o G__P__( ) Male/ Female ___ wks AOG
    PU______ weeks TOB: _______ am/pm
    TOC: STS: BF:
    LNMP:______EDD:________
    Suction: __ EINC: CMP/INC
    NSD/CS/RCS sec to:______
    AS:________ FH: _________
    Steroids Y / N
    BS: _______ EFW: _______
    CC:
    BW: _______
    BL: _______ Naloxone:___
    HPI: HC:________ EPI: _______
    CC: ________ NaHCO3:____
    AC: ________ ET tube:____
    I_______________________ GA:_________
    ________________________ Pla: ________
    ________________________
    ________________________ EFW: (FH - 12) x (0.155) -NE
    ________________________ (FH - 11) x (0.155) – E
    Naloxone: (EFW/4)
    II_______________________ Epinephrine: (EFW x 0.1)
    ________________________ NaHCO3: (EFW x 2)
    ________________________ ET Tube: (EFW < 3 = 3, 3-4 = 3.5; >3 =
    4)
    ________________________
    ________________________
    III______________________ PMHx:
    ________________________
    ________________________
    ________________________ FamHx:
    ________________________

    PSHx: __ NS __NABD
    TIME HR RR TEMP MX

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