Maternity Post-Discharge Follow-up Checklist

Mother's Name:

Date of Discharge:

Contact Number:

Infant's Name:

Date of Birth:

Follow-up Date:

Checklist

Maternal vital signs assessed
Uterine involution checked
Lochia character and amount assessed
Perineal or incision site checked for healing
Signs of infection ruled out (mother & infant)
Breastfeeding or feeding assessment done
Advice on maternal warning signs given
Advice on infant danger signs given
Immunizations reviewed
Contraception options discussed
Emotional well-being/PPD screening
Follow-up appointments scheduled

Additional Notes

Provider Name:

Date:

Signature: