Patient Information
Name
Date of Birth
Age
Medical Record Number
Address
Contact Number
Admission Date
Admission Time
Obstetric History
Gravida
Para
Abortions
Living
Last Menstrual Period (LMP)
Estimated Due Date (EDD)
Gestational Age (weeks)
History of Previous Pregnancies
Current Pregnancy
Presenting Complaints
Medications & Supplements
Allergies
Pregnancy Complications (if any)
Physical Assessment
Height (cm)
Weight (kg)
Blood Pressure (mmHg)
Temperature (°C)
Pulse (bpm)
Respirations (per min)
General Examination
Fetal Assessment
Fetal Heart Rate (FHR)
Fetal Lie
Presentation/Position
Fetal Movements
Other Relevant Information
Medical History
Surgical History
Family History
Social History
Nutritional Status
Assessment Summary / Nursing Notes