Health Record For Baby Girls Page 4
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28Inj. Vitamin K
: Dose
: ___________________ Route : _________________
Delivered by
: _____________________________________________________
Attended by (Paed.) : _____________________________________________________
Mother’s blood group : _____________________________________________________
Baby’s blood group : _____________________________________________________
Results of hearing test : Right ear : __________________________________________
Left ear : __________________________________________
Remarks : _______________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Your baby’s Examination Details
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
If circumcision was performed in this hospital
Date of circumcision
: ____________________________________________
Performed by
: ____________________________________________
Date & Time of discharge
: ____________________________________________
Baby’s Weight on discharge
: ____________________________________________
Advice for your baby on Discharge : ____________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Follow up appointment on __________________________ at ____________________
With Dr __________________________________________________________________
Name of discharging ______________________________________________________
doctor
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