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ITR Prenatal v.3

This document is a prenatal record for a client from the Naga Rural Health Unit in the Philippines. It contains information such as the client's personal details, medical history, current pregnancy details, and records of prenatal visits. During the prenatal visits, the client's vital signs, any vaccines or lab tests administered, assessments, and reminders about medications and checkups are documented. The prenatal visits help monitor the health and development of both the client and fetus throughout the pregnancy.

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SHEBA RAE ESPERANZA
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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358 views1 page

ITR Prenatal v.3

This document is a prenatal record for a client from the Naga Rural Health Unit in the Philippines. It contains information such as the client's personal details, medical history, current pregnancy details, and records of prenatal visits. During the prenatal visits, the client's vital signs, any vaccines or lab tests administered, assessments, and reminders about medications and checkups are documented. The prenatal visits help monitor the health and development of both the client and fetus throughout the pregnancy.

Uploaded by

SHEBA RAE ESPERANZA
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Republic of the Philippines

DEPARTMENT OF HEALTH
Naga Rural Health Unit
Poblacion, Naga, Zamboanga Sibugay

PRENATAL RECORD
______________________________ ______________________________
PHILHEALTH NUMBER CP NUMBER

CLIENT: _____________________________________________________ AGE: _________ DATE OF BIRTH_________________


LAST NAME FIRST NAME MIDDLE NAME
EDUC.ATTAINTMENT: _________________________ STATUS: _____ RELIGION: ____________ OCCUPATION: _____________
ADDRESS: ___________________________________________ MOTHER’S MAIDEN NAME: _________________________
HUSBAND: ________________________________________________ RELIGION: ____________ OCCUPATION: _____________
CHILDREN’S DATE OF BIRTH: 1ST___________ 2ND ___________ 3RD __________ 4th____________ 5th______________
TETANUS - DIPHTHERIA: 1ST___________ 2ND ___________ 3RD __________ 4th____________ 5th______________

DANGER SIGNS: PREVIOUS PREGNANCIES COMPLICATED WITH:


NAUSEA_____ VOMITING_______ HEADACHE____ HEMORRHAGE [ ] YES [ ] NO
EDEMA_____ DIZZINESS________ PRURITUS______ TOXEMIA [ ] YES [ ] NO
CRAMPS____ BLEEDING________ ANEMIA_______ PLACENTA PREVIA [ ] YES [ ] NO
BLURRING OF VISION_________ SEPSIS [ ] YES [ ] NO

PRESENT PREGNANCY: GRAVIDA_____ TERM_____ PRETERM_____ ABORTION_____ LIVING_____


LAST MENSTRUAL PERIOD (LMP):_____________ EXPECTED DATE OF CONFINEMENT (EDC): ________________
DATE OF LAST DELIVERY: ___________________ TYPE: [ ] NSVD [ ] CS

PRENATAL VISITS:
DATE VITAL SIGNS VACCINE/ LABS ASSESSMENT TEACHINGS/ REMINDERS REMARKS

BP: TD: AOG: FeSO4+FA: TCB:


WT: FUNDIC HT : CaCO3:
HT: BLOOD TYPE: FHT:
BMI: FETAL MOV’T:
HBsAg:
BP: AOG: FeSO4+FA: TCB:
WT: HCT: FUNDIC HT : CaCO3:
HT: FHT:
BMI: SYPH: FETAL MOV’T:

BP: AOG: FeSO4+FA: TCB:


UA:
WT: FUNDIC HT : CaCO3:
HT: FHT:
BMI: FETAL MOV’T:

BP: AOG: FeSO4+FA: TCB:


WT: FUNDIC HT : CaCO3:
HT: FHT:
BMI: FETAL MOV’T:

BP: AOG: FeSO4+FA: TCB:


WT: FUNDIC HT : CaCO3:
HT: FHT:
BMI: FETAL MOV’T:

BP: AOG: FeSO4+FA: TCB:


WT: FUNDIC HT : CaCO3:
HT: FHT:
BMI: FETAL MOV’T:

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