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Patient’s Name: hours at ___ mL level.

Case #:

Age/B-Day: Signed:
TIME:
Patient’s Name:
Address: Case #:

____>Received from LR/RR per wheelchair Age:


accompanied by _________ with an ongoing TIME:
IVF of ____+ __‘u’ oxytocin X __ hours at ___
Address:
mL level infusing well on the ____ arm.
____>Received from LR/RR per wheelchair
>Assisted on DR table, comfortably
accompanied by _________ with an ongoing
placed in lithotomy position.
IVF of ____+ __‘u’ oxytocin X __ hours at ___
>Oxygen inhalation administered at 2- mL level infusing well on the ____ arm.
3 lpm via nasal cannula.
>Assisted on DR table, comfortably
>Right medio lateral episiotomy done placed in lithotomy position.
by Dr/Clerk/Intern ___________.
>Oxygen inhalation administered at 2-
____>Delivered to an alive baby _____ via 3 lpm via nasal cannula.
Normal Spontaneous Delivery attended by
>Right medio lateral episiotomy done
Dr/Clerk/Intern___________.
by Dr/Clerk/Intern ___________.
____>Cord clamping done by Dr/Clerk/Intern
____>Delivered to an alive baby _____ via
________ after cord pulsation ceased.
Normal Spontaneous Delivery attended by
____>Placenta out, complete by Dr/Clerk/Intern___________.
Shultz/Duncan presentation.
____>Cord clamping done by Dr/Clerk/Intern
>BP taken and recorded as ____mmHg. ________ after cord pulsation ceased.

____>Additional oxytocin of __’u’ ____>Placenta out, complete by


incorporated to present IVF. Shultz/Duncan presentation.

____>Methylergometrine 1 amp given >BP taken and recorded as ____mmHg.


intramuscular at right/left deltoid.
____>Additional oxytocin of __’u’
>Evacuation of blood clots and incorporated to present IVF.
placental fragments done by Dr.__________.
____>Methylergometrine 1 amp given
>Episiorrhaphy done by Dr._________. intramuscular at right/left deltoid.

>Perineal care and betadine swab >Evacuation of blood clots and


done. placental fragments done by Dr.__________.

>Placed adult diaper and secured. >Episiorrhaphy done by Dr._________.

>Brought to recovery room per >Perineal care and betadine swab


stretcher accompanied by _______ with an done.
ongoing IVF of ____+ __‘u’ oxytocin X __
>Placed adult diaper and secured.
>Brought to recovery room per
stretcher accompanied by _______ with an
ongoing IVF of ____+ __‘u’ oxytocin X __
hours at ___ mL level.

Signed: