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  • Mini Tickler

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    Trisha Mae Macatangay
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    The document appears to be a medical record template containing blank fields for documenting information about childbirth procedures for multiple patients. Key details that would be filled in include patient names, admission diagnosis, details of labor and delivery such as dilation and effacement, birth details like baby weight and Apgar scores, and medical interventions like IV insertion and suturing. The purpose of the document is to standardize collection of important metrics for documenting normal spontaneous vaginal deliveries.

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    mini-tickler

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    The document appears to be a medical record template containing blank fields for documenting information about childbirth procedures for multiple patients. Key details that would be filled in include patient names, admission diagnosis, details of labor and delivery such as dilation and effacement, birth details like baby weight and Apgar scores, and medical interventions like IV insertion and suturing. The purpose of the document is to standardize collection of important metrics for documenting normal spontaneous vaginal deliveries.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    35 views1 page

    Mini Tickler

    Uploaded by

    Trisha Mae Macatangay
    The document appears to be a medical record template containing blank fields for documenting information about childbirth procedures for multiple patients. Key details that would be filled in include patient names, admission diagnosis, details of labor and delivery such as dilation and effacement, birth details like baby weight and Apgar scores, and medical interventions like IV insertion and suturing. The purpose of the document is to standardize collection of important metrics for documenting normal spontaneous vaginal deliveries.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    of 1

    Procedure: ______________ Date: ________ Procedure: ______________ Date: ________ Procedure: ______________ Date: ________

    File No: _____________ Bed No.: ________ File No: _____________ Bed No.: ________ File No: _____________ Bed No.: ________
    Name: ______________________________ Name: ______________________________ Name: ______________________________
    Address: _____________________________ Address: _____________________________ Address: _____________________________
    ____________________________________ ____________________________________ ____________________________________
    Admitting Diagnosis: G___P___ (__ __ __ __) Admitting Diagnosis: G___P___ (__ __ __ __) Admitting Diagnosis: G___P___ (__ __ __ __)
    ____________________________________ ____________________________________ ____________________________________
    ____________________________________ ____________________________________ ____________________________________
    Dilatation ____cm, Effacement _____%, Dilatation ____cm, Effacement _____%, Dilatation ____cm, Effacement _____%,
    Station ____, BOW ____ IE time: Station ____, BOW ____ IE time: Station ____, BOW ____ IE time:
    _________ _________ _________
    Complete Diagnosis: G___P___ (__ __ __ Complete Diagnosis: G___P___ (__ __ __ Complete Diagnosis: G___P___ (__ __ __
    __) __) __)
    Pregnancy Uterine ______ weeks, Cephalic Pregnancy Uterine ______ weeks, Cephalic Pregnancy Uterine ______ weeks, Cephalic
    delivered spontaneously to an alive baby delivered spontaneously to an alive baby delivered spontaneously to an alive baby
    _______, (_____grams-____cm) Apgar _______, (_____grams-____cm) Apgar _______, (_____grams-____cm) Apgar
    Score ____,_____. Repair of _______ degree Score ____,_____. Repair of _______ degree Score ____,_____. Repair of _______ degree
    laceration/Perineal Support laceration/Perineal Support laceration/Perineal Support
    IV insertion: ________ Baby out: _________ IV insertion: ________ Baby out: _________ IV insertion: ________ Baby out: _________
    Placenta out: ________ Suture: ___________ Placenta out: ________ Suture: ___________ Placenta out: ________ Suture: ___________

    Procedure: ______________ Date: ________ Procedure: ______________ Date: ________ Procedure: ______________ Date: ________
    File No: _____________ Bed No.: ________ File No: _____________ Bed No.: ________ File No: _____________ Bed No.: ________
    Name: ______________________________ Name: ______________________________ Name: ______________________________
    Address: _____________________________ Address: _____________________________ Address: _____________________________
    ____________________________________ ____________________________________ ____________________________________
    Admitting Diagnosis: G___P___ (__ __ __ __) Admitting Diagnosis: G___P___ (__ __ __ __) Admitting Diagnosis: G___P___ (__ __ __ __)
    ____________________________________ ____________________________________ ____________________________________
    ____________________________________ ____________________________________ ____________________________________
    Dilatation ____cm, Effacement _____%, Dilatation ____cm, Effacement _____%, Dilatation ____cm, Effacement _____%,
    Station ____, BOW ____ IE time: Station ____, BOW ____ IE time: Station ____, BOW ____ IE time:
    _________ _________ _________
    Complete Diagnosis: G___P___ (__ __ __ Complete Diagnosis: G___P___ (__ __ __ Complete Diagnosis: G___P___ (__ __ __
    __) __) __)
    Pregnancy Uterine ______ weeks, Cephalic Pregnancy Uterine ______ weeks, Cephalic Pregnancy Uterine ______ weeks, Cephalic
    delivered spontaneously to an alive baby delivered spontaneously to an alive baby delivered spontaneously to an alive baby
    _______, (_____grams-____cm) Apgar _______, (_____grams-____cm) Apgar _______, (_____grams-____cm) Apgar
    Score ____,_____. Repair of _______ degree Score ____,_____. Repair of _______ degree Score ____,_____. Repair of _______ degree
    laceration/Perineal Support laceration/Perineal Support laceration/Perineal Support
    IV insertion: ________ Baby out: _________ IV insertion: ________ Baby out: _________ IV insertion: ________ Baby out: _________
    Placenta out: ________ Suture: ___________ Placenta out: ________ Suture: ___________ Placenta out: ________ Suture: ___________

    Procedure: ______________ Date: ________ Procedure: ______________ Date: ________ Procedure: ______________ Date: ________
    File No: _____________ Bed No.: ________ File No: _____________ Bed No.: ________ File No: _____________ Bed No.: ________
    Name: ______________________________ Name: ______________________________ Name: ______________________________
    Address: _____________________________ Address: _____________________________ Address: _____________________________
    ____________________________________ ____________________________________ ____________________________________
    Admitting Diagnosis: G___P___ (__ __ __ __) Admitting Diagnosis: G___P___ (__ __ __ __) Admitting Diagnosis: G___P___ (__ __ __ __)
    ____________________________________ ____________________________________ ____________________________________
    ____________________________________ ____________________________________ ____________________________________
    Dilatation ____cm, Effacement _____%, Dilatation ____cm, Effacement _____%, Dilatation ____cm, Effacement _____%,
    Station ____, BOW ____ IE time: Station ____, BOW ____ IE time: Station ____, BOW ____ IE time:
    _________ _________ _________
    Complete Diagnosis: G___P___ (__ __ __ Complete Diagnosis: G___P___ (__ __ __ Complete Diagnosis: G___P___ (__ __ __
    __) __) __)
    Pregnancy Uterine ______ weeks, Cephalic Pregnancy Uterine ______ weeks, Cephalic Pregnancy Uterine ______ weeks, Cephalic
    delivered spontaneously to an alive baby delivered spontaneously to an alive baby delivered spontaneously to an alive baby
    _______, (_____grams-____cm) Apgar _______, (_____grams-____cm) Apgar _______, (_____grams-____cm) Apgar
    Score ____,_____. Repair of _______ degree Score ____,_____. Repair of _______ degree Score ____,_____. Repair of _______ degree
    laceration/Perineal Support laceration/Perineal Support laceration/Perineal Support
    IV insertion: ________ Baby out: _________ IV insertion: ________ Baby out: _________ IV insertion: ________ Baby out: _________
    Placenta out: ________ Suture: ___________ Placenta out: ________ Suture: ___________ Placenta out: ________ Suture: ___________

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