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Delivery Room Case Record Template

The document outlines a series of delivery room cases, including both assisted and handled deliveries, as well as cord dressing cases. Each case includes sections for patient information, delivery details, and staff involvement, with a requirement for computations related to estimated due date (EDC), last menstrual period (LMP), and age of gestation (AOG). Additionally, there is a section for labor watch data to monitor patient status during labor.

Uploaded by

Jacob Clint Lipura
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
81 views16 pages

Delivery Room Case Record Template

The document outlines a series of delivery room cases, including both assisted and handled deliveries, as well as cord dressing cases. Each case includes sections for patient information, delivery details, and staff involvement, with a requirement for computations related to estimated due date (EDC), last menstrual period (LMP), and age of gestation (AOG). Additionally, there is a section for labor watch data to monitor patient status during labor.

Uploaded by

Jacob Clint Lipura
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

DELIVERY ROOM CASES

Assisted Delivery No.: 1

Hospital Number :

Name of Hospital :

Patient’s Name :

Age :

Address :

Status :

Room Number :

Parity :

LMP :

EDC :

AOG :

Type of Delivery :

Date of Delivery :

Time of Delivery :

Gender of the Baby :

Anesthesia :

Attending Physician :

OB - Resident :

Diagnosis :

Type of Placental Presentation :

Time of Placental Separation :

Type of Episiotomy :

__ ________________________
Student's Name Midwife On Duty Staff Nurse On Duty

______________________ ________________________
Clinical Instructor Evaluator

(Please show computation on EDC,LMP & AOG)


DELIVERY ROOM CASES

Assisted Delivery No.: 2

Hospital Number :

Name of Hospital :

Patient’s Name :

Age :

Address :

Status :

Room Number :

Parity :

LMP :

EDC :

AOG :

Type of Delivery :

Date of Delivery :

Time of Delivery :

Gender of the Baby :

Anesthesia :

Attending Physician :

OB - Resident :

Diagnosis :

Type of Placental Presentation :

Time of Placental Separation :

Type of Episiotomy :

__ ____________
Student's Name Midwife On Duty Staff Nurse On Duty

______________________ ________________________
Clinical Instructor Evaluator

(Please show computation on EDC,LMP & AOG)


DELIVERY ROOM CASES

Assisted Delivery No.: 3

Hospital Number :

Name of Hospital :

Patient’s Name :

Age :

Address :

Status :

Room Number :

Parity :

LMP :

EDC :

AOG :

Type of Delivery :

Date of Delivery :

Time of Delivery :

Gender of the Baby :

Anesthesia :

Attending Physician :

OB - Resident :

Diagnosis :

Type of Placental Presentation :

Time of Placental Separation :

Type of Episiotomy :

__ ____________
Student's Name Midwife On Duty Staff Nurse On Duty

______________________ ________________________
Clinical Instructor Evaluator

(Please show computation on EDC,LMP & AOG)


DELIVERY ROOM CASES

Assisted Delivery No.: 4

Hospital Number :

Name of Hospital :

Patient’s Name :

Age :

Address :

Status :

Room Number :

Parity :

LMP :

EDC :

AOG :

Type of Delivery :

Date of Delivery :

Time of Delivery :

Gender of the Baby :

Anesthesia :

Attending Physician :

OB - Resident :

Diagnosis :

Type of Placental Presentation :

Time of Placental Separation :

Type of Episiotomy :

__ ____________
Student's Name Midwife On Duty Staff Nurse On Duty

______________________ ________________________
Clinical Instructor Evaluator

(Please show computation on EDC,LMP & AOG)


DELIVERY ROOM CASES

Assisted Delivery No.: 5

Hospital Number :

Name of Hospital :

Patient’s Name :

Age :

Address :

Status :

Room Number :

Parity :

LMP :

EDC :

AOG :

Type of Delivery :

Date of Delivery :

Time of Delivery :

Gender of the Baby :

Anesthesia :

Attending Physician :

OB - Resident :

Diagnosis :

Type of Placental Presentation :

Time of Placental Separation :

Type of Episiotomy :

__ ____________
Student's Name Midwife On Duty Staff Nurse On Duty

______________________ ________________________
Clinical Instructor Evaluator

(Please show computation on EDC,LMP & AOG)


DELIVERY ROOM CASES

Handled Delivery No.: 1

Hospital Number :

Name of Hospital :

Patient’s Name :

Age :

Address :

Status :

Room Number :

Parity :

LMP :

EDC :

AOG :

Type of Delivery :

Date of Delivery :

Time of Delivery :

Gender of the Baby :

Anesthesia :

Attending Physician :

OB - Resident :

Diagnosis :

Type of Placental Presentation :

Time of Placental Separation :

Type of Episiotomy :

__ ____________
Student's Name Midwife On Duty Staff Nurse On Duty

______________________ ________________________
Clinical Instructor Evaluator

(Please show computation on EDC,LMP & AOG)


DELIVERY ROOM CASES

Handled Delivery No.: 2

Hospital Number :

Name of Hospital :

Patient’s Name :

Age :

Address :

Status :

Room Number :

Parity :

LMP :

EDC :

AOG :

Type of Delivery :

Date of Delivery :

Time of Delivery :

Gender of the Baby :

Anesthesia :

Attending Physician :

OB - Resident :

Diagnosis :

Type of Placental Presentation :

Time of Placental Separation :

Type of Episiotomy :

__ ____________
Student's Name Midwife On Duty Staff Nurse On Duty

______________________ ________________________
Clinical Instructor Evaluator

(Please show computation on EDC,LMP & AOG)


DELIVERY ROOM CASES

Handled Delivery No.: 3

Hospital Number :

Name of Hospital :

Patient’s Name :

Age :

Address :

Status :

Room Number :

Parity :

LMP :

EDC :

AOG :

Type of Delivery :

Date of Delivery :

Time of Delivery :

Gender of the Baby :

Anesthesia :

Attending Physician :

OB - Resident :

Diagnosis :

Type of Placental Presentation :

Time of Placental Separation :

Type of Episiotomy :

__ ____________
Student's Name Midwife On Duty Staff Nurse On Duty

______________________ ________________________
Clinical Instructor Evaluator

(Please show computation on EDC,LMP & AOG)


DELIVERY ROOM CASES

Handled Delivery No.: 4

Hospital Number :

Name of Hospital :

Patient’s Name :

Age :

Address :

Status :

Room Number :

Parity :

LMP :

EDC :

AOG :

Type of Delivery :

Date of Delivery :

Time of Delivery :

Gender of the Baby :

Anesthesia :

Attending Physician :

OB - Resident :

Diagnosis :

Type of Placental Presentation :

Time of Placental Separation :

Type of Episiotomy :

__ ____________
Student's Name Midwife On Duty Staff Nurse On Duty

______________________ ________________________
Clinical Instructor Evaluator

(Please show computation on EDC,LMP & AOG)


DELIVERY ROOM CASES

Handled Delivery No.: 5

Hospital Number :

Name of Hospital :

Patient’s Name :

Age :

Address :

Status :

Room Number :

Parity :

LMP :

EDC :

AOG :

Type of Delivery :

Date of Delivery :

Time of Delivery :

Gender of the Baby :

Anesthesia :

Attending Physician :

OB - Resident :

Diagnosis :

Type of Placental Presentation :

Time of Placental Separation :

Type of Episiotomy :

__ ____________
Student's Name Midwife On Duty Staff Nurse On Duty

______________________ ________________________
Clinical Instructor Evaluator

(Please show computation on EDC,LMP & AOG)


DELIVERY ROOM CASES

Cord Dressed No.: 1

Hospital Number :

Name of Hospital :

Patient’s Name :

Age :

Address :

Status :

Room Number :

Parity :

LMP :

EDC :

AOG :

Type of Delivery :

Date of Delivery :

Time of Delivery :

Gender of the Baby :

Anesthesia :

Attending Physician :

OB - Resident :

Diagnosis :

Type of Placental Presentation :

Time of Placental Separation :

Type of Episiotomy :

__ ____________
Student's Name Midwife On Duty Staff Nurse On Duty

______________________ ________________________
Clinical Instructor Evaluator

(Please show computation on EDC,LMP & AOG)


DELIVERY ROOM CASES

Cord Dressed No.: 2

Hospital Number :

Name of Hospital :

Patient’s Name :

Age :

Address :

Status :

Room Number :

Parity :

LMP :

EDC :

AOG :

Type of Delivery :

Date of Delivery :

Time of Delivery :

Gender of the Baby :

Anesthesia :

Attending Physician :

OB - Resident :

Diagnosis :

Type of Placental Presentation :

Time of Placental Separation :

Type of Episiotomy :

__ ____________
Student's Name Midwife On Duty Staff Nurse On Duty

______________________ ________________________
Clinical Instructor Evaluator

(Please show computation on EDC,LMP & AOG)


DELIVERY ROOM CASES

Cord Dressed No.: 3

Hospital Number :

Name of Hospital :

Patient’s Name :

Age :

Address :

Status :

Room Number :

Parity :

LMP :

EDC :

AOG :

Type of Delivery :

Date of Delivery :

Time of Delivery :

Gender of the Baby :

Anesthesia :

Attending Physician :

OB - Resident :

Diagnosis :

Type of Placental Presentation :

Time of Placental Separation :

Type of Episiotomy :

__ ____________
Student's Name Midwife On Duty Staff Nurse On Duty

__ ____
Clinical Instructor Evaluator

(Please show computation on EDC,LMP & AOG)

(Please show computation on EDC,LMP & AOG)


DELIVERY ROOM CASES

Cord Dressed No.: 4

Hospital Number :

Name of Hospital :

Patient’s Name :

Age :

Address :

Status :

Room Number :

Parity :

LMP :

EDC :

AOG :

Type of Delivery :

Date of Delivery :

Time of Delivery :

Gender of the Baby :

Anesthesia :

Attending Physician :

OB - Resident :

Diagnosis :

Type of Placental Presentation :

Time of Placental Separation :

Type of Episiotomy :

__ ____________
Student's Name Midwife On Duty Staff Nurse On Duty

__ ____
Clinical Instructor Evaluator

(Please show computation on EDC,LMP & AOG)


DELIVERY ROOM CASES

Cord Dressed No.: 5

Hospital Number :

Name of Hospital :

Patient’s Name :

Age :

Address :

Status :

Room Number :

Parity :

LMP :

EDC :

AOG :

Type of Delivery :

Date of Delivery :

Time of Delivery :

Gender of the Baby :

Anesthesia :

Attending Physician :

OB - Resident :

Diagnosis :

Type of Placental Presentation :

Time of Placental Separation :

Type of Episiotomy :

__ ____________
Student's Name Midwife On Duty Staff Nurse On Duty

__ ____
Clinical Instructor Evaluator

(Please show computation on EDC,LMP & AOG)


DATA FOR LABOR WATCH

Patient’s Name :

Age :

Status :

Parity :

BOW :

Ruptured Time :

DATE TIME BP T P R DURATION INTERVAL FREQUENCY FHR

______________________ ________________________
Student's Name Staff Nurse On Duty

Clinical Instructor Level Chairman

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