Name: _________________________________ Age: _____ Gender: ______ G: ______ P: ______ A: ______

G: ______ P: ______ A: ______ In: _________________

In: _________________ Out: ________________
Out: ________________ Bow: _______________
Bow: _______________ BP: ________________ HR: _________ RR: ________ T: _________
BP: ________________ HR: _________ RR: ________ T: _________ Bb out: _____________ BP: _________ HR: ________
Bb out: _____________ BP: _________ HR: ________ Placenta out: _________ BP: _________ HR: ________
Placenta out: _________ BP: _________ HR: ________ Postpartum V/S: BP: _________ HR: ________ T: _________
Postpartum V/S: BP: _________ HR: ________ T: _________ RR: _________
RR: _________ Baby’s Record
Baby’s Record Measurement VS Time Given
Measurement VS Time Given HC: ________ T: ________ Eye ointment: ___________
HC: ________ T: ________ Eye ointment: ___________ CC: _________ HR: _______ Vit K: ______________________
CC: _________ HR: _______ Vit K: ______________________ AC: _________ RR: _______ Hep B: _____________________
AC: _________ RR: _______ Hep B: _____________________ L: ___________ BCG: ______________________
L: ___________ BCG: ______________________ WT: _________ Oxytoxin: ___________________
WT: _________ Oxytoxin: ___________________ AS: _________
AS: _________ Doctor: Mother: __________________________ Handle: _____________________
Doctor: Mother: __________________________ Handle: _____________________ Doctor: Baby: ____________________________ Assisst: _____________________
Doctor: Baby: ____________________________ Assisst: _____________________ NoD: ___________________________________ Cord Care: __________________
NoD: ___________________________________ Cord Care: __________________ Supervisor: ______________________________
Supervisor: ______________________________
MONITORING HOURLY
MONITORING HOURLY NAME
NAME Time
Time T
T HR
HR RR
RR BP
BP
FHT
FHT

Name: _________________________________ Age: _____ Gender: ______