1. The document is a prenatal record for a patient of the Doong Maternity Clinic in Makilala, Cotabato.
2. It collects information such as the patient's name, birthdate, address, contact details, medical and obstetric history, and birth plan.
3. The patient's birth plan is to give birth at the Doong Maternity Clinic, which is a PhilHealth-accredited facility, and to be transported there by the clinic's vehicle if emergency referral is needed.
1. The document is a prenatal record for a patient of the Doong Maternity Clinic in Makilala, Cotabato.
2. It collects information such as the patient's name, birthdate, address, contact details, medical and obstetric history, and birth plan.
3. The patient's birth plan is to give birth at the Doong Maternity Clinic, which is a PhilHealth-accredited facility, and to be transported there by the clinic's vehicle if emergency referral is needed.
1. The document is a prenatal record for a patient of the Doong Maternity Clinic in Makilala, Cotabato.
2. It collects information such as the patient's name, birthdate, address, contact details, medical and obstetric history, and birth plan.
3. The patient's birth plan is to give birth at the Doong Maternity Clinic, which is a PhilHealth-accredited facility, and to be transported there by the clinic's vehicle if emergency referral is needed.
1. The document is a prenatal record for a patient of the Doong Maternity Clinic in Makilala, Cotabato.
2. It collects information such as the patient's name, birthdate, address, contact details, medical and obstetric history, and birth plan.
3. The patient's birth plan is to give birth at the Doong Maternity Clinic, which is a PhilHealth-accredited facility, and to be transported there by the clinic's vehicle if emergency referral is needed.
NAME : __________________________________ BIRTHDAY : __________________ AGE: _________ MARITAL STATUS :___________________
ADDRESS :_________________________________CONTACT NO: ________________PHILHEALTH: ________________ Menarch: ____________ BIRTH PLAN: Ako ay papaanakin ni DOONG LMP: _____________________________________ EDC:________________________OB SCORE: __________________ HEIGHT :_____________ MATERNITY CLINIC HEALTH CARE Please assess the patient and check all the findings as you conduct your history taking specifically to the obstetrical and medical surgical risk factor. PROVIDER, ako ay manganganak sa OBSTETRICAL RISK FACTOR Multiple pregnancy Ovarian cyst Myoma uteri Placenta previa Abortion of three DOONG MATERNITY CLINIC, ito ay History of stillborn History of preeclampsia History of eclampsia Premature labor PHILHEALTH ACCREDITED na MEDICAL SURGICAL RISK FACTOR paanakan, ako ay PhilHealth Hypertension Heart disease Diabetes Thyroid disorder Obesity History of uterine member. Ang aking sasakyan Asthma Epilepsy Renal disease Bleeding disorder Previous CS myomectomy papunta sa paanakan ay FINDINGS FINDINGS FINDINGS FINDINGS FINDINGS FINDINGS LABORATORY RESULT: ___________.Kung may emergency DATE HGB: at kailangan kong irefer sa hospital, TIME ADMITTED Urine Analysis: TIME DISCHARGE HBSAG ako ay magpaparefer BLOOD PRESSURE ULTRASOUND RESULT: sa___________________________ RESPIRATORY RATE CARDIAC RATE _ at ang aking Doctor ay si TEMPERATURE _____________________________. WEIGHT AOG Ako ay ihahatid ng sasakyan ng FHT DOONG MATERNITY CLINIC. TT STATUS FUNDIC HEIGHT Observation OBSERVATION NOTED: OBSERVATION NOTED: OBSERVATION NOTED: ___________________________________ Signature of Patient
VITAMIN SUPPLEMENTATION ______________________________ Name and Signature of the Patient