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Pregnancy Record Updated PDF
Pregnancy Record Updated PDF
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PREGNANCY RECORD
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Blood Group BMI Height (cm) Allergies
MOH area
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PHM area
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Name of the Clinic
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Other Antenatal clinics
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@Oh U@~O Present obstetric History
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Registration No and date
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Yes No
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Consanguinity
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Rubella Immunization
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Pre-pregancy screening done
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History of subfertility
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Contraceptive method last used
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Diabetes Mellitus
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Highest Level Education Hypertension
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Psychiatric Illnesses
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Second trimester
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Respiratory System
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Breast Examination
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lnvestigations
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POA Result
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BMI
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ReferralslBack Referrals
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To be filled by the nursing staff at the discharge IV IIIIII
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Episiotomy YesINo Anti-D antibodies given
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Body Temperature Normal for last 2 Days Diagnosis card given if indicated
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YesINo YeslNo
Vaginal examination done to check packs CHDR completed and handed over
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Prescription given if needed YesINo
Any maternal complications. if yes Specify
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Family planning discussed
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Post parturn danger signals explained
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Address.. ..............:........................................................................................
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GIVE ONLY BREAST MILK FROM BIRTH TO COMPLETION OF 6 MONTHS (180 DAYS) OF AGE 2
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Partum Field Care
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ldentified post partum morbidities & Actions taken
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Identified problems in mother and
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Vaginal examination if needed
Special Notes
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2nd Trimester
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Yd Trimester
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Address ......................................................................................................... Telephone No
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Name and address of the contact person .......................................................................................................................................
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Telephone No * Telephone No of the MOH office
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START BREAST FEEDING WITHIN THE IST
HOUR AFTER BIRTH
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