FNCP
FNCP
FNCP
DATE (M/D/Y): __________ TIME: _________ DATE (M/D/Y): __/__/__ TIME: ___________ DATE (M/D/Y): __/__/__ TIME: ___________
H: ______ A: _________ BC: __________ MOTHERS NAME (L,F,M) _________________ MOTHERS NAME (L,F,M) _________________
Mothers Name (L,F,M): ___________________ BABY: (_) F (_) M BABY: (_) F (_) M
AGE: _____
LMP/AOG: ________ HT: ____ WT: _____ (_) sterile gloves (_) Wash hands
BP: ____ TEMP: ____ RR: _____ HR: _____ (_) drape (_) Gown
FH: _____ GTPAL: ___________________ (_) Cut cord (_) Sterile gloves
BUBBLE-HE: ________________________
NOTES: APGAR SCORE: 1min 5min Baby Out: ________
_________________________________________ Placenta Out: _______
_________________________________________ (_) Assist episiotomy
(_) Assist episorrhapy
(_) Clean gloves
(_) Open sterile equipments
ANTHROPOMETRICS:
Ht: ___ Wt: ___ MUAC: __
ANTHROPOMETRICS:
Ht: ___ Wt: ___ MUAC: __