Professional Documents
Culture Documents
Record System
Patient Data
c Ambulatory
c Stretcher
c Wheelchair
Pt
c Other ______________________________
E
D
D
L
M
P
c None
c Latex
c Food
c Other _______________________________________________
Allergy/Sensitivity
Age
DOB
c No Prenatal Care
MD/CNM
MD/PNP (Newborn)
p
r
o
Height
Physical Assessment
i
r
B
No
Yes
A
S
E
L
FHR/Contractions
TIME
TIME
FHR
TEMP
Cervical Exam
TIME
DILAT
VARIABILITY
ACCELS
PULSE
EFF
DECELS
RESP
STAT
FREQ
DURA
BP
INTEN
43
O2 SAT
3
2
7-
PRES
Exam by ________________
Notes /Interventions:____________________________________________
____________________________________________________________________
____________________________________________________________________
_____________________________________ Initials
Signature
_____________________________________
_____________________________________
_____________________________________
0
0
(8
Psychosocial Assessment
Observation Evaluation
c Fetal Status
c Ultrasound
c Amniocentesis
c NST c CST c FAST
c Fetal Movement
___________________
___________________
c Medical Complications
___________________
___________________
c Obstetric Complications
___________________
___________________
EFM/STRIP # ________________
P
M
.
w
w
m
o
.c
Vital Signs
C
s
gg
4
2
)
_________________________________________________________________________
Self Care Needs c None c _________________________________________________
Emotional Status c Happy c Ambivalent c Concerned c Depressed
c Angry c Other___________________________________________
Amt /Day
Last Used
Time
_______________ ____ /____ /____ ___________
_______________ ____ /____ /____ ___________
_______________ ____ /____ /____ ___________
_______________ ____ /____ /____ ___________
Disposition
Date____/____/____ Time_________________
c Antepartum Bleeding
c False Labor - Undelivered
c Transfer to ______________________________________
c Hyperemesis Gravidarum
c Placenta Previa
c Preeclampsia
c Premature Labor - Resolved
c PROM x _______ Hours
Diet
c Incompetent Cervix
c Active Labor
Medications
c UTI
c ________________________
Instructions
________________________________
c Routine (or) ______________________
Follow up
Where _____________________________
c ________________________
When ______________________________
Orders ______________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
MD Signature
Date / Time
____________________________________________________
RN Signature
Date / Time