Country Experiences
Recommendation for practice
The birth certificate form (T.r. 1/1) in this handbook signed
by health personnel to certify the birth of the child is neither
an official birth certificate nor birth registration. Parents should
contact the district or local registration officer at district/
sub-district office, municipality office, or Bangkok
Metropolitan Administration Office to register the birth of the
child in order to get an official Birth Certificate and to add the
childûs name into the household record within 15 days after
birth. Parents should bring with them this handbook, a copy of
household record, and the identification card of the childûs
mother or father when registering for the official Birth
Certificate. If you register later than 15 days, you as the
parents, will be fined for 1,000 baht by the law.
Documents required for official birth registration :
1. A copy of household record.
2. Identification card of the childûs mother or father.
3. Marriage license of the parents (if any).
For your childûs well-being:
If the mother is physically and mentally
healthy, then the child will be healthy and happy.
Good physical and mental health of mother has resulted from the
good care of the husband.
Name-Surname of Child
Please do not lose
this handbook
Please bring this handbook with you every time you come in for services
at the government and private hospitals.
This handbook can be used as a reference for obtaining your babyûs Birth Registration Certificate,
and adding your childûs name into the household record
Ministry of Public Health 2555 (2012)
Good Practice of Mother for Bringing a Healthy Child
1. Having children at the ages between 20-35
6. The childûs birth-weight is 2,500 grams
years
Spacing between each child for at least 2
years.
Together with the husband, having ANC
visit soonest before 12 weeks of gestational age, following every appointment of
ANC visits, and having the delivery by
medical and health personnel.
Receiving complete doses of T.T.vaccine.
Having self-practice during the pregnancy
delivery, and postpartum periods as recommended in MCH handbook.
or more.
Having the baby suck breastmilk
instantly after birth with exclusive
breastfeeding for at least 6 months,
continuing breastfeeding for at least 24
months along with other food for ages.
Bringing up a healthy child without
malnutrition and obesity.
Promoting the childûs age appropriate
development as recommended in MCH
handbook.
Bringing the child to receive vaccinations on appointments.
2.
3.
4.
5.
7.
8.
9.
10.
Mother and Child Health Handbook
Published by Bureau of Health Promotion, Department of Health, Ministry of Pubic Health, Thailand
Total
102 pages
1st Printing: 1400 copies
Printing Office : The Veteran Press, Bangkok
Chaiman of Advisory group
Dr.Vichai Tienthavorn
Former Permanent Secretary, Ministry of Health
Consultants
Dr.Somyos Deerasamee
Director-General, Department of Health
Dr.Somsak Pattarakulwanich Deputy Director-General, Department of Health
Dr.Sompong Sakulisariyaporn Director of Bureau of Health Promotion,
Department of Health
Editors
Dr.Nipunporn Woramongkol
Bureau of Technical Advisors Department of Health
Dr.Sirikul Issaranurak
Professor Emeritus, Mahidol University
Dr.Sarawut Boonsuk
Chief of Maternal and Child Health Group
Mrs.Nareeluck Kullurk
Public Health Technical Officer, Senior Professional Level
Mrs.Chailai Leartvanangkul
Public Health Technical Officer, Senior Professional Level
Ms.Sukjing Worngdechakul
Nutritionist, Senior Professional Level
Mrs.Jintana Pattanapongthorn Public Health Technical Officer, Senior Professional Level
Dissemination Technical Officer, Senior Professional Level
Mrs.Nongluk Roongsubsin
Mrs.Prapaporn Jungpanich
Public Health Technical Officer, Professional Level
Mrs.Isaree Jedprayuk
Public Health Technical Officer, Professional Level
Ms.Chaweewan Tonputsa
Public Health Technical Officer, Professional Level
1
ID
General Identification Number ..........................................
(Pregnant woman)
Child's
General Identification Number (Child)................................ Photograph
Firstly Issued at...................................................................
Name-surname of pregnant woman............................................................
Identification Number
Occupation............................. Religion................................................
Education (Highest educational attainment).......................................
Telephone number...............................................................................
Name-surname of the husband...................................................................
Identification Number
Occupation............................. Religion................................................
Education (Highest educational attainment).......................................
Telephone number...............................................................................
Current address No.............. Moo..............Name of village........................
Soi..............................Street...........................Sub-district.............................
District...................... Province...........................Zip Code
Name-surname of the child........................................ Blood group............
Date of birth.........Month................ Year 20...... time of delivery....... hrs.
Identification Number
If anyone picks up or finds this handbook, please reture it to the above address
2
Introduction to the Use of MCH Handbook
This MCH handbook is a personal health record for the mother
during pregnancy, intra-partum, and post-partum periods, and for the
child since birth up until 6 years of age.
Advantages
™
™
™
A source of knowledge and record for the health of mother and
child from pregnancy up until the child is 6 years old.
Helping the father and mother to take appropriate care for their
child from birth up until 6 years olds.
Providing an evidence for notification of birth and obtaining a
birth certificate using the form T.R.1/1 signed by the birth attendant presented in this handbook.
Instruction
™
™
™
™
™
Read through and follow all the contents in this handbook.
Bring along this book whenever you receive services at any
health facilities.
Record the data all by yourself and have your husband record
the data on the pages as identified.
When your child attends school, hand over this book to the
teacher for continuous care of the childûs health.
If the book is torn or lost, obtain the new one from health
personnel.
If you have any doubts or questions about this
handbook, please ask the health personnel
CONTENTS
Page
Page
General I.D. number (pregnant woman) 1
Introduction to the use of MCH handbook 2
Part 1 Pregnancy
4
■ Health history of pregnant woman
4
and family
■ Risk assessment criteria for pregnant
5
woman at the 1st ANC visit
■ History of current pregnancy
6
■ Pregnancy examination record
7
■ Checklists of care for quality pregnant
9
woman
■ Checklists of service inclusion by
10
gestational age
■ Uterine heigh graph
11
■ Fetal movement count
12
■ Maternal delivery record
15
■ Record of the newborn
16
Part 2 Child Care
17
■ Risks assessment in mother and
17-18
newborn (prior to hospital discharge)
■ Oral health for children aged 6
19
months › 5 years
■ Child Development and service
20-39
activities for children aged 1 month›4 years
■ Head circumference graph
40-41
(separated for male and female)
■ Guide to the use of child nutritional graph 42
■ Child nutritional graph
43-54
Part 3 Essential Knowledge for Safe
55
and Quality Pregnancy
■ Discomforts during pregnancy
56
■ Maternal practice during pregnancy
57
■ Table of minimum weight for pregnant
58
woman to give birth to a newborn of
2,500 g.
■ Self care during pregnancy using
59-60
pregnancy pathway chart
■ Table of minimum weight for pregnant
61
woman to give birth to a newborn
> 2,500 g.
■ Advantage of nutritional graph
63
■ Nutritional graph for pregnant woman
64
■ Nutrition for pregnancy women:
65-66
Table for comparison of percentage
of standard BMI values (BMI 21 = 100)
■ Illustration of sets of food exchange 67-68
for pregnant woman
■ Fetal development
69
■ Thalassemia
70-71
■ What is hypothyroidism?
72
■ Prevention of mother-to-child
73
transmission of HIV
■ Family planning
74
■ Self assessment and analysis
75-76
of stress
Part 4 Child related knowledge to bring
77
up a healthy, brilliant, good, happy child
■ Breast-milk is the first drop of family
78
love bond
■ Food for infant at birth › 12 months 79-80
■ Adequate amount of daily food intake
81
for a child 1 › 5 years
■ Caring for your child
82
■ Caring for your child suffering from
83
respiratory tract infection
■ Caring for your childûs teeth
84
■ Vaccinations guide
85
■ Miracle of reading
86
■ Guide to bringing up a brilliant, good,
87
happy child
■ Suggestion for parents and guardian in
88
recording the childûs development
■ Child development promotion
89-97
■ Risks and guide to prevention of
98-100
injuries in early childhood
■ Childûs vaccination record
101
■ Next appointment date for health exam 102
PART 1: PREGNANCY
4
PART 1: PREGNANCY
Health History of Pregnant Woman and Family
(recorded by pregnant woman)
Having been married for........yrs. Use......as a contraceptive method forÇ.years/Ç.months.
Most recently stop using contraception before pregnancy forÇÇ.yrs./Ç.months.
Pregnancy History
Pregnancy D/M/Y
delivery/
abortion
Gesta- Delivery/ Method Birthtional abortion
of
weight
age(wks)
delivery/
abortion
Sex
Place Complica- Current
of
tions Status of
delivery/
infant
abortion
1
2
3
4
5
6
History of Illnesses
Diabetes
Hypertension
Heart Disease
Thyroid
Anemia
Thalassemia
Others................................
History of surgeries ...................in the year........at.......................................Hospital
...................in the year........at.......................................Hospital
History of drug allergy Name of the drug..........................Symptom.................................
Name of the drug..........................Symptom.................................
History of illnesses and pregnancies of family members
Seizure
Diabetes
Hypertension
Congenital anomaly
Multiple pregnancy
Mental retardation
Others....................
History of menstruation cycle Regular/irregular menstruationÇÇÇand at everyÇ..days
PART 1: PREGNANCY
5
Risk Assessment Criteria
for
st
Pregnant Woman at the 1 ANC Visit
(assessed by health personnel)
Item
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
Criteria for Assessment
No
Yes
Past History
Stillbirth or neonatal death (first 1 month)
3 consecutive abortions
Having baby with birth wieight < 2,500 g.
Having baby with birth wieight > 4,000 g.
Hospitalized for hypertension treatment during pregnancy or
toxemia of pregnancy
Undergone surgery of reproductive system organ such as
myoma, mypmecomy, cervical cerclage, etc.
Current History
Multifetal pregnancy
Age < 17 years (up to EDC)
Age > 35 years (up to EDC)
Rh Negative
Vaginal bleeding
Pelvic myoma
Diastolic pressure ≥90 mmHg
Diabetes
Kidney disease
Heart disease
Drug addiction, alcohol addiction
Other diseases of internal medicine such as anemia, thyroid,
SLE, tc. (please specify)..............................................................
If any of the responses fall into çYesé, the new approach of pregnancy care is not
applicable to the pregnant woman and special care and/or additional assessment
should be employed.
AssessorÇÇÇÇÇÇÇÇÇÇÇÇÇÇÇÇÇ.ÇÇÇ.DateÇÇÇÇÇÇÇÇÇÇÇÇÇÇ
PART 1: PREGNANCY
6
History of Current Pregnancy
(recorded by health personnel)
Pregnancy #........Last menstrual period.......................Expected due date.....................
Weight before pregnancy.......kg. Height.......cms. BMI before pregnancy.................
Number of C/S.......Number of living children.........Age of the last child........yrs.......months
Laboratory Test
■
■
■
■
■
■
■
■
1st time
2nd time
Blood test for HBsAg
1st time
Blood test for Hematocrit 1st time
2nd time
STIs (VDRL)
Date...................... Result.......................
Date...................... Result.......................
Date...................... Result.......................
Date...................... Result.......................
Date...................... Result.......................
Screening for Thalassemia (Wife) Date......................
Result OF............DCIP..............MCV..............
(Husband) Date......................
Result OF............DCIP..............MCV..............
Blood group and
(Wife) Blood group......Rh......Hemoglobin type....
Hemoglobin type
(Husband) Blood group......Rh......Hemoglobin type....
Other examination results...........................................................................................
Couple counseling Pre-blood test Date......................
Pre-blood test Date......................
Participation in parental school activities 1st time at gestational age............months
2nd time at gestational age............months
Tetanus Toxoid Vaccination
(Recorded by health personnel)
Received vaccination before pregnancy..............times.
Date of most recent vaccination.......................................................................................
Vaccination is not given for this pregnancy as the 3rd dose was given no more
than 10 years or with previous tetanus vaccinations for 5 times.
1st Dose, date.............................................................................................................
2nd Dose, date............................................................................................................
Booster Dose, date......................................................................................................
Stories and tales promote your child's intelligence with the sense of morality
PART 1: PREGNANCY
PART 1: PREGNANCY
7
Result of U/S exam, day....................................
BPD.......................................FL.............................
Fetal position......................Gestational age.............
Date Weight
of
Kg.
Exam
Urine Exam
Bacteria/
Protein/Sugar
8
Record of Pregnancy Examination
(recorded by health personnel)
Blood Size of
Fetal
Fetal
Fetal
Gestational
Pressure Uterure position/ heart movement age (wks.)
mm.Hg. (cm.) presentation sound
Corrected EDC...................
By LMP
PV U/S
Ut Size
GA............wks Sign...............Date..................
General physical
exam and risks
assessment
Diagnosis and Appointment Officer
Treatment
Place
Diabetes screening.............................................................................................................. Other special exam...............................................................................................................
.............................................................................................................................................................................................................................................................................................
PART 1: PREGNANCY
PART 1: PREGNANCY
9
10
Checklists of Service Inclusion by Gestational Age
(recorded by health personnel)
1st Visit, Date
(should be before 12 weeks)
DateÇÇÇÇ.........(should
Checklists of Service Inclusion by Gestational Age
(recorded by health personnel)
Weeks
The birth certificate form (T.r. 1/1) in this handbook signed
by health personnel to certify the birth of the child is neither
an official birth certificate nor birth registration. Parents should
contact the district or local registration officer at district/
sub-district office, municipality office, or Bangkok
Metropolitan Administration Office to register the birth of the
child in order to get an official Birth Certificate and to add the
childûs name into the household record within 15 days after
birth. Parents should bring with them this handbook, a copy of
household record, and the identification card of the childûs
mother or father when registering for the official Birth
Certificate. If you register later than 15 days, you as the
parents, will be fined for 1,000 baht by the law.
Documents required for official birth registration :
1. A copy of household record.
2. Identification card of the childûs mother or father.
3. Marriage license of the parents (if any).
For your childûs well-being:
If the mother is physically and mentally
healthy, then the child will be healthy and happy.
Good physical and mental health of mother has resulted from the
good care of the husband.
Name-Surname of Child
Please do not lose
this handbook
Please bring this handbook with you every time you come in for services
at the government and private hospitals.
This handbook can be used as a reference for obtaining your babyûs Birth Registration Certificate,
and adding your childûs name into the household record
Ministry of Public Health 2555 (2012)
Good Practice of Mother for Bringing a Healthy Child
1. Having children at the ages between 20-35
6. The childûs birth-weight is 2,500 grams
years
Spacing between each child for at least 2
years.
Together with the husband, having ANC
visit soonest before 12 weeks of gestational age, following every appointment of
ANC visits, and having the delivery by
medical and health personnel.
Receiving complete doses of T.T.vaccine.
Having self-practice during the pregnancy
delivery, and postpartum periods as recommended in MCH handbook.
or more.
Having the baby suck breastmilk
instantly after birth with exclusive
breastfeeding for at least 6 months,
continuing breastfeeding for at least 24
months along with other food for ages.
Bringing up a healthy child without
malnutrition and obesity.
Promoting the childûs age appropriate
development as recommended in MCH
handbook.
Bringing the child to receive vaccinations on appointments.
2.
3.
4.
5.
7.
8.
9.
10.
Mother and Child Health Handbook
Published by Bureau of Health Promotion, Department of Health, Ministry of Pubic Health, Thailand
Total
102 pages
1st Printing: 1400 copies
Printing Office : The Veteran Press, Bangkok
Chaiman of Advisory group
Dr.Vichai Tienthavorn
Former Permanent Secretary, Ministry of Health
Consultants
Dr.Somyos Deerasamee
Director-General, Department of Health
Dr.Somsak Pattarakulwanich Deputy Director-General, Department of Health
Dr.Sompong Sakulisariyaporn Director of Bureau of Health Promotion,
Department of Health
Editors
Dr.Nipunporn Woramongkol
Bureau of Technical Advisors Department of Health
Dr.Sirikul Issaranurak
Professor Emeritus, Mahidol University
Dr.Sarawut Boonsuk
Chief of Maternal and Child Health Group
Mrs.Nareeluck Kullurk
Public Health Technical Officer, Senior Professional Level
Mrs.Chailai Leartvanangkul
Public Health Technical Officer, Senior Professional Level
Ms.Sukjing Worngdechakul
Nutritionist, Senior Professional Level
Mrs.Jintana Pattanapongthorn Public Health Technical Officer, Senior Professional Level
Dissemination Technical Officer, Senior Professional Level
Mrs.Nongluk Roongsubsin
Mrs.Prapaporn Jungpanich
Public Health Technical Officer, Professional Level
Mrs.Isaree Jedprayuk
Public Health Technical Officer, Professional Level
Ms.Chaweewan Tonputsa
Public Health Technical Officer, Professional Level
1
ID
General Identification Number ..........................................
(Pregnant woman)
Child's
General Identification Number (Child)................................ Photograph
Firstly Issued at...................................................................
Name-surname of pregnant woman............................................................
Identification Number
Occupation............................. Religion................................................
Education (Highest educational attainment).......................................
Telephone number...............................................................................
Name-surname of the husband...................................................................
Identification Number
Occupation............................. Religion................................................
Education (Highest educational attainment).......................................
Telephone number...............................................................................
Current address No.............. Moo..............Name of village........................
Soi..............................Street...........................Sub-district.............................
District...................... Province...........................Zip Code
Name-surname of the child........................................ Blood group............
Date of birth.........Month................ Year 20...... time of delivery....... hrs.
Identification Number
If anyone picks up or finds this handbook, please reture it to the above address
2
Introduction to the Use of MCH Handbook
This MCH handbook is a personal health record for the mother
during pregnancy, intra-partum, and post-partum periods, and for the
child since birth up until 6 years of age.
Advantages
™
™
™
A source of knowledge and record for the health of mother and
child from pregnancy up until the child is 6 years old.
Helping the father and mother to take appropriate care for their
child from birth up until 6 years olds.
Providing an evidence for notification of birth and obtaining a
birth certificate using the form T.R.1/1 signed by the birth attendant presented in this handbook.
Instruction
™
™
™
™
™
Read through and follow all the contents in this handbook.
Bring along this book whenever you receive services at any
health facilities.
Record the data all by yourself and have your husband record
the data on the pages as identified.
When your child attends school, hand over this book to the
teacher for continuous care of the childûs health.
If the book is torn or lost, obtain the new one from health
personnel.
If you have any doubts or questions about this
handbook, please ask the health personnel
CONTENTS
Page
Page
General I.D. number (pregnant woman) 1
Introduction to the use of MCH handbook 2
Part 1 Pregnancy
4
■ Health history of pregnant woman
4
and family
■ Risk assessment criteria for pregnant
5
woman at the 1st ANC visit
■ History of current pregnancy
6
■ Pregnancy examination record
7
■ Checklists of care for quality pregnant
9
woman
■ Checklists of service inclusion by
10
gestational age
■ Uterine heigh graph
11
■ Fetal movement count
12
■ Maternal delivery record
15
■ Record of the newborn
16
Part 2 Child Care
17
■ Risks assessment in mother and
17-18
newborn (prior to hospital discharge)
■ Oral health for children aged 6
19
months › 5 years
■ Child Development and service
20-39
activities for children aged 1 month›4 years
■ Head circumference graph
40-41
(separated for male and female)
■ Guide to the use of child nutritional graph 42
■ Child nutritional graph
43-54
Part 3 Essential Knowledge for Safe
55
and Quality Pregnancy
■ Discomforts during pregnancy
56
■ Maternal practice during pregnancy
57
■ Table of minimum weight for pregnant
58
woman to give birth to a newborn of
2,500 g.
■ Self care during pregnancy using
59-60
pregnancy pathway chart
■ Table of minimum weight for pregnant
61
woman to give birth to a newborn
> 2,500 g.
■ Advantage of nutritional graph
63
■ Nutritional graph for pregnant woman
64
■ Nutrition for pregnancy women:
65-66
Table for comparison of percentage
of standard BMI values (BMI 21 = 100)
■ Illustration of sets of food exchange 67-68
for pregnant woman
■ Fetal development
69
■ Thalassemia
70-71
■ What is hypothyroidism?
72
■ Prevention of mother-to-child
73
transmission of HIV
■ Family planning
74
■ Self assessment and analysis
75-76
of stress
Part 4 Child related knowledge to bring
77
up a healthy, brilliant, good, happy child
■ Breast-milk is the first drop of family
78
love bond
■ Food for infant at birth › 12 months 79-80
■ Adequate amount of daily food intake
81
for a child 1 › 5 years
■ Caring for your child
82
■ Caring for your child suffering from
83
respiratory tract infection
■ Caring for your childûs teeth
84
■ Vaccinations guide
85
■ Miracle of reading
86
■ Guide to bringing up a brilliant, good,
87
happy child
■ Suggestion for parents and guardian in
88
recording the childûs development
■ Child development promotion
89-97
■ Risks and guide to prevention of
98-100
injuries in early childhood
■ Childûs vaccination record
101
■ Next appointment date for health exam 102
PART 1: PREGNANCY
4
PART 1: PREGNANCY
Health History of Pregnant Woman and Family
(recorded by pregnant woman)
Having been married for........yrs. Use......as a contraceptive method forÇ.years/Ç.months.
Most recently stop using contraception before pregnancy forÇÇ.yrs./Ç.months.
Pregnancy History
Pregnancy D/M/Y
delivery/
abortion
Gesta- Delivery/ Method Birthtional abortion
of
weight
age(wks)
delivery/
abortion
Sex
Place Complica- Current
of
tions Status of
delivery/
infant
abortion
1
2
3
4
5
6
History of Illnesses
Diabetes
Hypertension
Heart Disease
Thyroid
Anemia
Thalassemia
Others................................
History of surgeries ...................in the year........at.......................................Hospital
...................in the year........at.......................................Hospital
History of drug allergy Name of the drug..........................Symptom.................................
Name of the drug..........................Symptom.................................
History of illnesses and pregnancies of family members
Seizure
Diabetes
Hypertension
Congenital anomaly
Multiple pregnancy
Mental retardation
Others....................
History of menstruation cycle Regular/irregular menstruationÇÇÇand at everyÇ..days
PART 1: PREGNANCY
5
Risk Assessment Criteria
for
st
Pregnant Woman at the 1 ANC Visit
(assessed by health personnel)
Item
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
Criteria for Assessment
No
Yes
Past History
Stillbirth or neonatal death (first 1 month)
3 consecutive abortions
Having baby with birth wieight < 2,500 g.
Having baby with birth wieight > 4,000 g.
Hospitalized for hypertension treatment during pregnancy or
toxemia of pregnancy
Undergone surgery of reproductive system organ such as
myoma, mypmecomy, cervical cerclage, etc.
Current History
Multifetal pregnancy
Age < 17 years (up to EDC)
Age > 35 years (up to EDC)
Rh Negative
Vaginal bleeding
Pelvic myoma
Diastolic pressure ≥90 mmHg
Diabetes
Kidney disease
Heart disease
Drug addiction, alcohol addiction
Other diseases of internal medicine such as anemia, thyroid,
SLE, tc. (please specify)..............................................................
If any of the responses fall into çYesé, the new approach of pregnancy care is not
applicable to the pregnant woman and special care and/or additional assessment
should be employed.
AssessorÇÇÇÇÇÇÇÇÇÇÇÇÇÇÇÇÇ.ÇÇÇ.DateÇÇÇÇÇÇÇÇÇÇÇÇÇÇ
PART 1: PREGNANCY
6
History of Current Pregnancy
(recorded by health personnel)
Pregnancy #........Last menstrual period.......................Expected due date.....................
Weight before pregnancy.......kg. Height.......cms. BMI before pregnancy.................
Number of C/S.......Number of living children.........Age of the last child........yrs.......months
Laboratory Test
■
■
■
■
■
■
■
■
1st time
2nd time
Blood test for HBsAg
1st time
Blood test for Hematocrit 1st time
2nd time
STIs (VDRL)
Date...................... Result.......................
Date...................... Result.......................
Date...................... Result.......................
Date...................... Result.......................
Date...................... Result.......................
Screening for Thalassemia (Wife) Date......................
Result OF............DCIP..............MCV..............
(Husband) Date......................
Result OF............DCIP..............MCV..............
Blood group and
(Wife) Blood group......Rh......Hemoglobin type....
Hemoglobin type
(Husband) Blood group......Rh......Hemoglobin type....
Other examination results...........................................................................................
Couple counseling Pre-blood test Date......................
Pre-blood test Date......................
Participation in parental school activities 1st time at gestational age............months
2nd time at gestational age............months
Tetanus Toxoid Vaccination
(Recorded by health personnel)
Received vaccination before pregnancy..............times.
Date of most recent vaccination.......................................................................................
Vaccination is not given for this pregnancy as the 3rd dose was given no more
than 10 years or with previous tetanus vaccinations for 5 times.
1st Dose, date.............................................................................................................
2nd Dose, date............................................................................................................
Booster Dose, date......................................................................................................
Stories and tales promote your child's intelligence with the sense of morality
PART 1: PREGNANCY
PART 1: PREGNANCY
7
Result of U/S exam, day....................................
BPD.......................................FL.............................
Fetal position......................Gestational age.............
Date Weight
of
Kg.
Exam
Urine Exam
Bacteria/
Protein/Sugar
8
Record of Pregnancy Examination
(recorded by health personnel)
Blood Size of
Fetal
Fetal
Fetal
Gestational
Pressure Uterure position/ heart movement age (wks.)
mm.Hg. (cm.) presentation sound
Corrected EDC...................
By LMP
PV U/S
Ut Size
GA............wks Sign...............Date..................
General physical
exam and risks
assessment
Diagnosis and Appointment Officer
Treatment
Place
Diabetes screening.............................................................................................................. Other special exam...............................................................................................................
.............................................................................................................................................................................................................................................................................................
PART 1: PREGNANCY
PART 1: PREGNANCY
9
10
Checklists of Service Inclusion by Gestational Age
(recorded by health personnel)
1st Visit, Date
(should be before 12 weeks)
DateÇÇÇÇ.........(should
Checklists of Service Inclusion by Gestational Age
(recorded by health personnel)
Weeks