ADMITTING NOTES

( )PIH
Identifying Data:
Name
Status
Age
OB Index Gynecology History:
Religion Occupation  Breast Disease  Hx of breast feeding/ Plans
Address
 Mammography/ Biopsy; Result
Date and Time Admitted
No. of Admission
Informant and Reliability
Chief Complaints  Gynecologic Surgery
 STD
History of Present Illness (HPI):

Family History:
( ) HPN ( ) DM ( ) Asthma
( ) Malignancies ( ) Multifetal ( ) Thyroid Diseases
Pregnancy

Personal & Social History :

Labor pain  Smoking sticks/day for about years.
Onset Frequency
 Alcohol beverage drinking   occasional or  frequent,
Duration Location
consuming about ______ glasses/session, for about _______ years.
Bloody Show
BOW
Onset Amount Physical Examination:
Ruptured/Intact General Appearance:
Vital Signs:
( ) Headache ( ) HPN ( ) Edema ( ) Convulsion BP Temp HR RR Wt Ht
( ) Visual disturbances ( ) Nausea and vomiting

UTZ Date Skin:

Result
HEENT:
Past Medical History:
Previous hospitalization/s: Neck:
Illness and Medications
taken: Chest & Lungs:
Previous surgeries/ accidents:
Allergies: Heart:
Menstrual History: Abdomen:
Menarche at ____ years old. Mensturation is ( ) regular or ( ) irregular of FHB _____________ location _____ .
_____ duration, heavy on _____ day, using _____ pad/ day. FH _________cm EFW ______ Kg
( ) Dysmennorhea.
Leopold’s manuever
Contraceptive Method Used: L1:
L2:
Obstetric Histor y: L3:
PMP EDC L4:
LMP AOG
Internal Examination:
OB Index: Introitus:
G P ( - - - ) Cervix:
Uterus:
TT Doses
Adnexae:
Discharge:
Prenatal check-up/s:
Medications during pregnancy:
Extremities:
Previous pregnancies:
IMPRESSION:
Rank Date Place Delivery AOG Complication
Type
G1
G2
G3
G4
G5
G6
G7
G8
G9
___________________ BASER, BABY HADJRIAH TAN
Nurse In-charge OB-GYN Senior Clerk