Name
Age
Occupation
Gravid Pramida
Chief complaint
LMP last menstrual period
EDD expecting due date
Period of amenorrhea
History of present illness ( pernah jumpe dr benda sama??,pernah masuk hospital benda sama??)
Antenatal history – upt,usg booking,follow ups,problems,medication,hb,blood group,weight,height
Gynaecology history – menarche,mense history,pap smear
Past obstetric history – year,at term??,pre term??,posterm??mode of delivery,sex,weight,complication
Medical n surgical history
Social history- married years,smoking,family income
Family history- same illness??
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