ASUHAN KEBIDANANA PADA IBU BERSALIN

KALA ………………………. a/n. Ny .............................................................................................................

Di........................................................................................................................................................................

No. MR :..............................................................................
MRS TGL/JAM :..............................................................................
A. Pengkajian tlg/jam ………………… oleh.....................................................................................................
1. Anamnesa ( data subyektif )
a. Identitas
PASIEN SUAMI
Nama :................................................. .....................................................................
Umur :................................................. .....................................................................
Suku/Bangsa :................................................. .....................................................................
Pendidikan :................................................. .....................................................................
Pekerjaan :................................................. .....................................................................
Alamat :................................................. .....................................................................

b. Keluhan / Alasan masuk RS

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............................................................................................................................................................
............................................................................................................................................................
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c. Riwayat Perkawinan
Menikah …….Kali. Menikah pertama umur …… tahun. Dengan suami sekarang sudah ……. Tahun

d. Riwayat Haid
Menarche umur …….. HPMT tg. ……. HPL tgl……. Umur Kehamilan minggu

e. Riwayat Obstetrik G = ……… P = …………, Ab = …………..., Ah =………

Jenis BBL Nifas

Umur Penolon
No Persalina
Kehamilan g BB L.Kep Menyusui Masalah
n