Professional Documents
Culture Documents
HP Card
HP Card
HP Card
Patient ID:
Attending Physician:
Age:
Birth Date:
Name:
Gender:
Chief Complaint:
Religion:
Medications:
Allergies:
Adult Illnesses:
HTN (Years, Highest BP, Usual BP):
DM (Years, Complications):
Cancer:
MI:
Thyroid Disorder:
CKD (Stage):
CHF
Childhood Illnesses
Immunizations (Tetanus shots)
Medications:
Smoker (sticks per day, years, stopped):
Travel History
Family History
DM:
Stroke:
Thyroid:
HPN:
Asthma:
PTB:
Cancer:
Others:
Travel History
Family History
HPN:
DM:
Stroke:
Thyroid:
Asthma:
PTB:
Cancer:
Others:
Menstrual History
Sexual History
Menarche
LMP
PMP
Duration bleeding:
Menopause
Amount:
OB History
OB SCORE: G
Physical Examination
AOG
EDC
Vital Signs
BP:
Anthropometric
Abdomen
Leopold
s
Pelvic Exam
Weight:
Fundic Height:
RR:
Height:
BMI:
FHR:
LM1
LM3
HR:
LM2
LM4
Speculum:
Internal Examination:
Physicians in charge
Admitting Diagnosis:
Plan:
Attending:
Resident:
Temp