Antenatal Outpatient Follow-Up Record
Patient Name
Hospital/Clinic No.
Date
Gestational Age (weeks)
Gravida/Para/Abortus
History / Complaints
Physical Examination
Blood Pressure (mmHg)
Pulse Rate (bpm)
Temperature (°C)
Fundal Height (cm)
Fetal Heart Rate (bpm)
Presentation
Laboratory / Investigations
Impression / Assessment
Plan / Management
Next Appointment
Attending Clinician