Beruflich Dokumente
Kultur Dokumente
_____________________
NAME
RUBELLA:
BABY:
POSTPARTUM
IMM / NON
MALE
/ FEMALE
DATE: ____________________
ADMIT TIME: ______________
PROVIDER:________________
G_________P_________
T
NEG / POS
NAME:
U/S: _______-________-_____
GEST:________________
C/O______________________
VDRL:
NEG / POS
TIME OF DELIVERY:
HIV:
NEG / POS
LAC:
BLOOD:
+
FOLEY:
BREAST
BLOOD:
FEEDING? Y
CONTRACTIONS:
______________PIT @__________
TIME:
IV MED/ EPIDURAL:
_________ RATE:________cc/h
BTL:
MARITAL:
S W D M_______________
ADV.DIR/WILL
q ______________
_________
_______________________
T_______ BP _______/_______
PAIN: 1 2 3 4 5 6 7 8 9 10
AGE:
CONSENT Y / N
WORK: NONE/_____________________
/ MOD/ STRONG
_______ HT:_______________
B AB
+
MEDS: ______________________
A O
/N
WANT? Y
/N
--
NEED RHOGAM: Y / N
PEE:
RUBELLA:
HEP B: Y / N
IMM / NON
NEG / POS
BLOOD:
VDRL:
NEG / POS
HIV:
NEG / POS
A O
COOMBS:
NEG
/N
B AB
+
--
/ POS
PKU: Y / N
APT/
MOBILE HOME
PREF: NONE/__________________
CHILDBIRTH
CLASS: Y
/N
FLUID_______RATE_________
RR_______HR _______ %_____
/ WATCH:
__________________________
PAIN: 1 2 3 4 5 6 7 8 9 10
__________________________
MEDS:___________________
__________________________
ABNORMALITIES/ PROBLEMS
T_______ BP _______/_______
__________________________
__________________________
VOIDING: Y
FOLEY Y / N
UP TO BATHROOM:
ILLNESS/ HX
REG
/N
/ CLEARS
GIFT:
BLACK
/N
/N
ATE YET? Y
BLUE FOLDER:
0 1 2 (3 SWOLLEN) 4
URINE DIPSTICK: 0 TR 1 2 3 4
HA: Y / N PAIN #__________
EPIGASTRIC PAIN: Y / N #____
REFLEXES: 0 1 2 3 4
CLONUS: Y / N
PLATELETS
POOP:
HEP B:
_____________________________
EDEMA:
/N
HEARING TEST: Y / N
/ FAMILY HX:
HAD EPIDURAL?
/N
__________________________
/ BOTTLE / BOTH
FLUID__________RATE_________
PEDI: _____________________
FHTS:
________/_________
NATURAL/
COLOR/ AMT:
APGARS:
GESTATION:_____DUBOWITZ:____
MEMBRANES:
INTACT / RUPTURED: __________
BLEED: Y/ N
0 1 2 3 4
PEDI: _____________________
FUNDUS ___________________
_____________________________
FREQUENCY
_________
WT:_______LBS_______OZ
B AB
SVE:________/________/_______
MILD
____________________
LMP: ______-________-_____
WKS
HEP B:
/N
/ WHITE BAG
/N