Name:: Admitting Diagnosis: Live Baby
Name:: Admitting Diagnosis: Live Baby
Name:: Admitting Diagnosis: Live Baby
Patient ID No.:
Resident In-charge:
Dr.
Dr.
Intern In-charge:
Date of Birth:
Time of Birth:
Clerk In-charge:
Name:
Admitting Diagnosis: Live baby BOY/GIRL born FULL TERM/PRETERM/POSTTERM ,
LMP to a AGE OF MOTHER years old OB SCORE G P ( F - T - P CS# SECONDARY TO,
AS
, , BW
A-L
weeks &
days AOG by
cm, HC
cm, CC
cm, AC
Apgar Score:
Ballard Score:
A/S/GA
HR
Temp
RR
O2 Sat
MBT
PBT
HbsAg
VDRL
OGTT
LMP
Antenatal History:
OB History:
Date:
Date:
Date:
cm.