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    (A.i) O&G PX Clerking Template

    Uploaded by

    Afkar Ishak
    This document appears to be a template for documenting a patient's obstetric history and current pregnancy. It includes sections for the patient's personal information, chief complaint, history of present illness, obstetric history, past medical history, social history, and review of systems. The document requests details about the current pregnancy, including gestational age, antenatal care received, fetal growth, and any complications. It also asks about the patient's menstrual, gynecologic, surgical, and obstetric histories.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    (A.i) O&G PX Clerking Template

    Uploaded by

    Afkar Ishak
    34 views4 pages
    This document appears to be a template for documenting a patient's obstetric history and current pregnancy. It includes sections for the patient's personal information, chief complaint, history of present illness, obstetric history, past medical history, social history, and review of systems. The document requests details about the current pregnancy, including gestational age, antenatal care received, fetal growth, and any complications. It also asks about the patient's menstrual, gynecologic, surgical, and obstetric histories.

    Original Title

    [a.I] O&G Px Clerking Template

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    This document appears to be a template for documenting a patient's obstetric history and current pregnancy. It includes sections for the patient's personal information, chief complaint, history of present illness, obstetric history, past medical history, social history, and review of systems. The document requests details about the current pregnancy, including gestational age, antenatal care received, fetal growth, and any complications. It also asks about the patient's menstrual, gynecologic, surgical, and obstetric histories.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    34 views4 pages

    (A.i) O&G PX Clerking Template

    Uploaded by

    Afkar Ishak
    This document appears to be a template for documenting a patient's obstetric history and current pregnancy. It includes sections for the patient's personal information, chief complaint, history of present illness, obstetric history, past medical history, social history, and review of systems. The document requests details about the current pregnancy, including gestational age, antenatal care received, fetal growth, and any complications. It also asks about the patient's menstrual, gynecologic, surgical, and obstetric histories.

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    © All Rights Reserved
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    You are on page 1of 4

    CLERK CASE NO.

    :
    DATE OF CLERKING!

    Informaton
    Name :

    Age:
    Para: Add ress:
    Religion: Race:
    Occupation:
    PoA: Date of admission:
    Husband's name: Husband's occupation:

    2: Chief Complain

    3. HOPI:
    Leg. GDM what, when, risk factor , medications diet contel.
    Site:

    Onset :

    Radiating'
    Alleviating
    Durathon L

    Exacerbating
    Associated Symptoms:
    Intensity:
    Previous Similar episode:

    History of Present Pregnancy (HOPP)


    Type of Pregnancy C Planned Unplanned (ART)
    How did she find out?

    How did she Confirm?


    Assured LMP
    Unsure Lmp REDD

    Pregnant at Weeks. days


    Symptoms 1St Trimester (13114 weeks) Morning Sickness ? weak?
    2nd
    Inmester (26127 weeks) HT? glycosuria?
    3" Trimester (28 birth discomfort infrequent pan?

    Antenatal Care
    Booting when:
    where 1
    PoA:
    • Bmi (
    NORMAL L OBESE (PREOBESE) Collers -specify
    Blood
    ( Hb level NORMAL L ABNORMAL ) IF abDOmaI(TIL
    Blood Group L
    Infechue Sreening clone HIV: Hepatitis 1
    Syphilis:
    Rubella:
    Unne Vaccination Status
    Protem AlT Cletanus): at
    eef of pregnancy
    -
    Glucose Dose no:
    others other vaccines.

    ( done / not done when :


    REDD:
    Some as EDD? YES/ND) Frequency of ANC visit:

    Fetal Growth:
    Fetal Abnomalrty Any hospital admission
    throughout pregnane4 ?
    USG : times of Sonogrami why ? when? what happened?
    week of gestation:
    How's baby's growth
    Liquor Medications presenbed?
    o

    Placenta what was given:


    Any fetal abnormality. noted? Symptom : (relieved / Persisknt ]wose)

    Current fetal movement


    Labbour Pain

    Leaking liquor, describe


    Subject:
    Date:

    5- Obstetric History
    Age of marriage Jo. of marriages:
    Difficult Vaqinal Delvery which chid?
    Significant Penneal trauma which Chld?
    Yost partum haemorrhage whch child?

    No Mode
    Maternal Complicahon Breast arth Neonatal
    Sex wher Complication
    (Ante lintra Post)

    History of C-SECTION ?

    G.
    Menstrual tisbn
    Menarche Vaginal Discharge
    Durahon (asl8]30 D cycle)
    Volume I amunt Chou many pads per dayl)
    others: dySmenorrheq? Hospitalised?
    an Compare to
    Blood clot? Size?( objects)

    Intermenstrual bleed? postioital beed?


    LMP ( when?)
    MatunM by dala (gestational age)

    7 Past Gynecelegy Hishry


    Contracephve histom
    Date of last PAPS MEAR, result, treatment

    Previous ectopic pregnancy , molar pregnanc


    Lecument mistamage
    Multiple previous I"tamesler terminahons
    Previous Gryne Surgery Lemtal [ bupsy
    St Suggestrg t/o
    of
    StoP (utteraton (dischanga)
    Breast
    self -examination (performed Inot), anything
    abnormal:
    MuHAmMA AFlAK 8|N ) 1s A

    8. Pasł Medical His hon Gif ye5 descnbe a t

    Past Sugreal Hiuos

    Prug. Alleg + Treatveot Hislny(Arey duo e dhari/ ep

    ScciaH
    Mavita| Sttus, clurehoa
    A ne avarla e t kel Lve w wo?
    Occu c hen
    F muy hcome (ste e ( usa

    to oea pro e
    Disłance h Care i ca rs
    Aohol EoshonTrpe
    Si
    o(as
    (poctyr - Ci 9 atoX of5b)
    SL Polon)
    SeXu
    Deg Aeldliched

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