Maternity Discharge Summary
Patient Details
Name:
Age:
Hospital No.:
Admission Date:
Discharge Date:
Consultant:
Obstetric History
Gravida
Para
Living
Abortions
Stillbirths
Antenatal Period
Lab Investigations
Hospital Course
Delivery Details
Date & Time of Delivery:
Mode of Delivery:
Attendant:
Indication:
Anesthesia:
Newborn Details
Baby's Sex:
Birth Weight:
APGAR (1/5 min):
Remarks:
Condition at Discharge
Medications & Advice
Consultant's Signature:
Date: