BIDAN

R I S M A N U R H A D I Y A N T I, Amd. Keb
Kp. Krajan Rt 01 Rw 01 Ds. Cibogohilir Kec. Plered Kab. Purwakarta HP 081380620652

ASUHAN KEBIDANAN ANC

Nama Istri : ............................................ Nama Suami : ...........................................

Umur : ............................................ Umur : ...........................................

Suku Bangsa : ............................................ Suku Bangsa : ...........................................

Agama : ............................................ Agama : ...........................................

Pendidikan : ............................................ Pendidikan : ...........................................

Alamat : ............................................ Alamat : ...........................................

............................................ ...........................................

Riwayat Obstetri Riwayat persalian yang lalu :

G P A H Anak I : Tahun ......... jenis kelamin L/P

HPHT : ................................ BB : .......gram

Jenis persalinan : ...........................

TP : ................................ Penolong : ......................................

BB / TB : ......../........ Anak II : Tahun ......... jenis kelamin L/P

Riwayat Penyakit : ....................................... BB : .......gram

....................................... Jenis Persalinan : ..........................

Imunisasi TT : ...........Kali Penolong : .....................................

Tgl/Jam S O A P
 BIDAN
R I S M A N U R H A D I Y A N T I, Amd. Keb
Kp. Krajan Rt 01 Rw 01 Ds. Cibogohilir Kec. Plered Kab. Purwakarta HP 081380620652

Tgl/Jam S O A P