Maternl Prenatal Visit Record


pregnancy

Enter your Email adress to begin:


VISIT FACILITY AND PROVIDER

Visit Facility:


Visit Provider:



PROVIDER ENTRY: PHYSICAL FINDINGS


Height(in):



Weight(lbs):



Pulse rate(bpm):



BP-Systolic: :



BP-Diaystolic:



Urine Protein:


Urine Glucose:


Urine Ketones:


General Condition:


HEENT:


Neck:


Breasts:


Lungs:


Heart:


Abdomen:


Extremities:


Integument(Skin):


Comments:/ Abnormal Findings:


PELVIC OBSTETRICAL EXAM

Uterine Size(weeks):



Fetal Heart Rate:



Cervical dilation(cm.):



Cervical Effacement(% x10):



Station(cm):


Consistency:


Cervical Position:


Presentation:


LABORATORY FINDINGS
Initial Pre-Natal Labs

Hemoglobin:


Hematocit:


WBC(,000):



Platelets:(,000):



Blood Type:


Rh Factor:


Antibody Screen:


Rubella:


VDRL:


Hepatitis B Antibody:


Hepatitis B Antigen:


HIV Antibody:


First Trimester Genetic Screening Method:


First Trimester Screening Results


AFP:




LABORATORY FINDINGS
Mid Trimester Labs

Glucose Screen:


GTT:


Hemoglobin:


Hematocit:


WBC:


Platelets:

HIV Antibody:



Antibody Screen:




ULTRASOUND FINDINGS

Anatomy Scan 18-20 Weeks:


Anatomy Scan Findings:


Additional Ultra Sound Findings:


BioPhysical Profile(BPP):


EFM / Non-Stress Testing:


Other Information: