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  • Formulir Kebidanan Pada Ibu Hamil

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    Budi waluyo
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    FORMULIR KEBIDANAN PADA IBU HAMIL

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    16 tayangan1 halaman

    Formulir Kebidanan Pada Ibu Hamil

    Diunggah oleh

    Budi waluyo

    Hak Cipta:

    © All Rights Reserved
    Unduh sebagai DOC, PDF, TXT atau baca online dari Scribd
    Tandai sebagai konten tidak pantas
    dari 1

    FORMULIR KEBIDANAN PADA IBU HAMIL

    NAMA MAHASISWA :...........................................................

    Tanggal Pengkajian :...........................................................

    Jam :..........................................................

    I. PENGKAJIAN
    A. DATA SUBYEKTIF
    1. IDENTITAS (BIODATA)
    Nama :.............................................. Nama Suami :.........................................
    Umur :.............................................. Umur :..........................................
    Suku / Bangsa :.............................................. Suku /Bangsa :..........................................
    Agama :.............................................. Agama :.........................................
    Pendidikan : ............................................. Pendidikan : .........................................
    Pekerjaan : ............................................. Pekerjaan : .........................................
    Penghasilan : ............................................. Penghasilan : .........................................
    Alamat Kantor : ............................................. Alamat kantor : .........................................
    ............................................. .........................................
    Alamat Rumah : ............................................. Alamat Rumah: .........................................
    .............................................. .........................................

    2. KELUHAN UTAMA :
    .................................................................................................................................................
    .................................................................................................................................................
    .................................................................................................................................................
    .................................................................................................................................................

    3. RIWAYAT MENSTRUASI :
    Menarche : ......................................... Haid sebelumnya :...................................
    HPHT : ......................................... Lama :...................................
    Lama : ......................................... Banyaknya :....................................
    Banyaknya : ......................................... HPL/HTP :...................................
    Siklus : .........................................
    Teratur/tidak : .........................................
    Dismenorhoe : .........................................
    Flour Albus : .........................................
    Wrana/bau : .........................................

    4. RIWAYAT KEHAMILAN SEKARANG :


    ANC TM 1 Berapa Kali :............................................................................
    Keluhan :............................................................................
    Terapi :.............................................................................
    TM II Berapa kali :............................................................................
    Keluhan :...........................................................................
    Terapi :.............................................................................
    TM III Berapa Kali :............................................................................
    Keluhan :...........................................................................
    Terapi :.............................................................................

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