FORMAT PENGKAJIAN
ASUHAN KEBIDANAN PADA IBU POST PARTUM / NIFAS
LANGKAH I : PENGKAJIAN
DATA SUBYEKTIF
A. Identitas
Identitas klien
Nama pasien : ............................. Nama suami : ........................
Umur : ............................. Umur : ........................
Agama : ............................. Agama : ........................
Suku/bangsa : ............................. Suku /bangsa : .......................
Pendidikan : ............................. Pendidikan : ........................
Pekerjaan : ............................. Pekerjaan : ........................
Alamat : ............................. Alamat : ........................
B. Keluhan utama / alasan kunjungan
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Riwayat kesehatan sekarang
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C. Riwayat kesehatan yang dahulu
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D. Riwayat kesehatan keluarga
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E. Riwayat menstruasi
Menarche :.................................. disminorhe : .........................
Siklus : ................................. flour albus : ..........................
Lama : .................................
F. Status perkawinan
Berapa kali menikah : ................................................................................
Umur pertama kali menikah
Suami : ............................................ Istri : …………………………………….
Lama : ........................................................................................................
G. Riwayat obstetri
LANGKAH VI : PELAKSANAAN
Tanggal :
Jam :
Implementasi :