-  IDENTIFICATION DATA - Name -
- Age -
- Residency -
- Education -
- Profession -
- Blood group -
- LMP ?
- G P[TPAL]
- Husband's Name -
- Husband's profession -
- Time since marriage ?
- Husband's Blood group ?
- [Booked/Unbooked]
- [Registered/Referred]
- EDD ?
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- Chief COMPLAINTS (great detail)
-  H/O PRESENT PREGNANCY - Period of amenorrhea ?
- Conceivement ? spontaneous/planned/treatment
- Realization of pregnancy ? symptoms / test kit / other
- Confirmation of pregnancy ?
 1st Trimester 2nd Trimester 3rd Trimester - Nausea-Vomiting
- Folic Acid tablet (Yellow)
- Ultrasound (& date?)
- Tetanus toxoid
- Fever
- Pain - abd./pelvic/back
- Burning micturition
- Discharge
- Bleeding p/v
- ANC visit?
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- Quickening - date?
- Ultrasound
- Tetanus toxoid?
- Fever
- Pain - Abd/pelvic/back
- Bleeding - p/v
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- ANC visits
- Bleeding p/v
 
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-  PAST OBSTETRICS HISTORY ? * for each pregnancy * - Pregnancy
- # Outcome of pregnancy
- # Gestational age at delivery
- Delivery
- # Normal/C-section (Why?)
- # LABOR - induced/spontaneous normal/prolonged
- * if Abortion (method of abort.) # Place of delivery ?
- # Complications ?
- Perperium
- Complications
- Baby
- # Gender
- # Age (current)
- # Birth Wt.
- # Breastfeeding
- # Immunization
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-  MENSTRUAL HISTORY - # Menarch - Age
- # Cycle - No. of days
- # Rhythm - Regular / Irregular
- # Post-coital bleeding
- # Contraceptive use
- * Note LNMP here if not noted before
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- Family History
-  Personal History - Diet
- Smoking
- Alcoholism
 
-  PAST HISTORY - H/o blood transfusion
- Any surgery
- Chronic disease-
- DM
- HTN
- TB
- Pelvic inflammatory Disease
- Other (medicine History)
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-  Allergy - Drug allergy
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This download link is referred from the post: MBBS Lecture Notes for all subjects (updated for 2021 syllabus) - All universities
