Handle DR 1

You might also like

Download as docx, pdf, or txt
Download as docx, pdf, or txt
You are on page 1of 1

HANDLE VAGINAL DELIVERY

NO. _____

CASE NUMBER:___________ DATE:___________

NAME OF PATIENT: ________________________________________________


AGE: ________ BIRTHDAY:_________ SEX:________ STATUS:_________
COMPLETE ADDRESS: ____________________________________________________
OBSTETRICAL HISTORY:

GRAVIDA: ____ G___T__P__A__L___


PARA::_____
LMP: ___________EDC:____________AOG:______________________

COMPLETE DIAGNOSIS:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

DATE OF DELIVERY:____________________ TIME OF DELIVERY:______________________


NATURE OF DELIVERY:____________________________________________
PLACENTA OUT: ______________(TIME)
_______________(PRESENTATION)
SEX OF BABY: _________________ APGAR SCORING: _________ ________
BABY ANTHROPOMETRIC MEASUREMENT (cm) & WEIGHT ( kg ):
HC: ______ CC:______ AC:________ LENGTH:________ WEIGHT:_________

NAME OF THE FACILITY: _______________________________________________________________


ADDRESS OF THE FACILITY: _____________________________________________________________

ASSISTED BY: ___________________________


HANDLED BY: ___________________________ (Name of student)
CORD CARE BY: __________________________ ( Name of Student)
SUPERVISED BY:

_______________________ ______________________
NURSE ON DUTY MIDWIFE ON DUTY

________________________
CLINICAL INSTRUCTOR

_______________________
OR/DR SUPERVISOR

You might also like