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Prenatal record sample

Prenatal record template 2025

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The document is an antepartum record used for documenting essential information about a pregnant patient, including personal details, medical history, pregnancy history, and initial physical examination findings. It captures data such as the patient's demographics, past pregnancies, medical conditions, symptoms since the last menstrual period, laboratory results, and plans for prenatal care. The form serves as a comprehensive tool for healthcare providers to monitor the health of both the mother and fetus throughout the pregnancy.

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Click ‘Get Form’ to open the prenatal record template in the editor.
Begin by entering the date and your name in the designated fields. Ensure you include your last, first, and middle names for accurate identification.
Fill in your ID number, hospital of delivery, and newborn’s physician details. This information is crucial for medical records.
Complete the sections regarding your personal details such as age, race, occupation, education level, and address. This helps healthcare providers understand your background.
Provide information about your pregnancy history including final estimated due date (EDD), past pregnancies, and any complications experienced. This section is vital for assessing risks.
Review and fill out the medical history section thoroughly. Include any allergies or previous medical conditions that may affect your pregnancy.
Once all fields are completed, save your document. You can easily share it with healthcare providers directly from our platform.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How to take an OB/GYN history?

Taking a gynecologic history consists of asking patients about any symptoms or concerns that prompted the visit. The history should include a menstrual history, sexual history, urinary tract symptoms or history, and previous or current gynecologic conditions and treatments.

What is included in the prenatal record form and why?

Prenatal records typically include a comprehensive baseline prenatal health history form, risk assessment tools, and additional forms or flow sheets for on-going documentation of care during prenatal visits and childbirth [4].

What is the ACOG antenatal record?

The ACOG Antepartum Record is a standardized tool developed by the American College of Obstetricians and Gynecologists (ACOG) to document important clinical information regarding a pregnant patients health and progress during the antepartum period.

What to ask in prenatal history?

Things youll be asked about include: Your menstrual history. Your reproductive history. Health problems in your family, such as heart disease or genetic conditions . Your general health. Any medicines you take regularly. Any habits that could affect your pregnancy, such as tobacco, alcohol, or drug use.

How to take prenatal history?

Initial Prenatal Visit. Blood type. Estimated Gestational Age 1420 Weeks (When Indicated) Maternal serum -fetoprotein or multiple marker screen. Estimated Gestational Age 2428 Weeks. Hemoglobin or hematocrit. Estimated Gestational Age 3236 weeks. Optional Laboratory Studies (When Indicated)

prenatal flow sheet

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What is a prenatal history?

The components of a prenatal record include all the initial demographics, family, and personal medical and genetic history, complete physical examination and laboratory testing, and provides room for additional records and serial examinations to be recorded in a fashion to allow trending.

What is the acog form?

The ACOG Form is a patient consent form for the American College of Obstetricians and Gynecologists. It is used to document the consent of a patient regarding the proposed medical care or procedure.

How do you take pregnancy history?

Taking an obstetric history usually begins with asking about previous pregnancies, including dates, outcomes, and complications. For pregnant patients, a more detailed obstetric history is taken regarding prior pregnancies and the current pregnancy.