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462 STUDENT’S CASE BOOK

IUCD INSERTIONS

I. IDENTIFICATION DATA

Name of the patient W/O

Date Age Reg. No. / I.P No

Hospital / Institution Name Religion

Obstetric Score G P L A

Timing of Insertion : Following child birth / Abortion / Others

II. PRELIMINARIES FOR IUCD INSERTION

• Previous Medical and Surgical history :

• Mestural History :

• Physical Examinations :

• Vaginal Examination :
STUDENT’S CASE BOOK 463

III.STEPS CARRIED DURING IUCD INSERTION

IV. EDUCATION OF THE WOMEN

Date :

SIGNATURE OF STUDENT SIGNATURE OF SUPERVISIOR


464 STUDENT’S CASE BOOK

IUCD INSERTIONS

I. IDENTIFICATION DATA

Name of the patient W/O

Date Age Reg. No. / I.P No

Hospital / Institution Name Religion

Obstetric Score G P L A

Timing of Insertion : Following child birth / Abortion / Others

II. PRELIMINARIES FOR IUCD INSERTION

• Previous Medical and Surgical history :

• Mestural History :

• Physical Examinations :

• Vaginal Examination :
STUDENT’S CASE BOOK 465

III.STEPS CARRIED DURING IUCD INSERTION

IV. EDUCATION OF THE WOMEN

Date :

SIGNATURE OF STUDENT SIGNATURE OF SUPERVISIOR


466 STUDENT’S CASE BOOK

IUCD INSERTIONS

I. IDENTIFICATION DATA

Name of the patient W/O

Date Age Reg. No. / I.P No

Hospital / Institution Name Religion

Obstetric Score G P L A

Timing of Insertion : Following child birth / Abortion / Others

II. PRELIMINARIES FOR IUCD INSERTION

• Previous Medical and Surgical history :

• Mestural History :

• Physical Examinations :

• Vaginal Examination :
STUDENT’S CASE BOOK 467

III.STEPS CARRIED DURING IUCD INSERTION

IV. EDUCATION OF THE WOMEN

Date :

SIGNATURE OF STUDENT SIGNATURE OF SUPERVISIOR


468 STUDENT’S CASE BOOK

IUCD INSERTIONS

I. IDENTIFICATION DATA

Name of the patient W/O

Date Age Reg. No. / I.P No

Hospital / Institution Name Religion

Obstetric Score G P L A

Timing of Insertion : Following child birth / Abortion / Others

II. PRELIMINARIES FOR IUCD INSERTION

• Previous Medical and Surgical history :

• Mestural History :

• Physical Examinations :

• Vaginal Examination :
STUDENT’S CASE BOOK 469

III.STEPS CARRIED DURING IUCD INSERTION

IV. EDUCATION OF THE WOMEN

Date :

SIGNATURE OF STUDENT SIGNATURE OF SUPERVISIOR


470 STUDENT’S CASE BOOK

IUCD INSERTIONS

I. IDENTIFICATION DATA

Name of the patient W/O

Date Age Reg. No. / I.P No

Hospital / Institution Name Religion

Obstetric Score G P L A

Timing of Insertion : Following child birth / Abortion / Others

II. PRELIMINARIES FOR IUCD INSERTION

• Previous Medical and Surgical history :

• Mestural History :

• Physical Examinations :

• Vaginal Examination :
STUDENT’S CASE BOOK 471

III.STEPS CARRIED DURING IUCD INSERTION

IV. EDUCATION OF THE WOMEN

Date :

SIGNATURE OF STUDENT SIGNATURE OF SUPERVISIOR

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