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G	Type (Smart)	Sex	Status	Time Since Delivery	Address	Indication	❌
		Single Male Female Twins Twins (M+M) Twins (F+F) Twins (M+F) Triplets Triplets (M+M+M) Triplets (F+F+F) Triplets (Mixed)	Single Baby Alive Died After Stillbirth Neonatal Death Abortion Twins Both Alive 1 Alive, 1 Died Both Died Triplets All 3 Alive 2 Alive, 1 Died 1 Alive, 2 Died All 3 Died

Past Medical, Contraceptive & Surgical History

Medical History (Chronic)

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Contraceptive History

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Surgical History

Vital Signs

Weight (Kg)

BP (mm Hg)

Pulse (bpm)

Temp (°F)

SpO2 (%)

P/S (Cervix)

P/V (Uterus)

FHS (B/Min)

Weeks of Pregnancy

PA (B/D) - By Dates

*Auto-calculated from LMP

Weeks (By USG)

*Calculated from USG EDD

PA (Clinical Weeks)

Manual Entry (Per Abdomen)

Odema

Pallor

Urine Albumin

Clinical Remarks

USG Findings (Summary)

🩸 ANC Profile, Vaccines & Investigations

Husband's Blood Group

Wife's (Patient) Blood Group

Vaccines (Doses)

TT Dose 1

TT Dose 2

D-Tap

Flu Vac

Investigations (Lab Reports)

Hb %

OGTT (Sugar)

RBS (Sugar)

VDRL

HIV

HBsAg

TSH

S. Prolactin

NT/NB Scan

Dual Marker

Quadruple Marker

UPT Results & Dates

Doppler Study

NST Result

Urine R/M

Anomaly Scan

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Medicine Name

Timing (Dosage)

Instruction

Duration

Lab Advice

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⚡ Radiology / Sonography

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🩺 Procedures / Services

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