Antenatal Booking visit forms

A first-ever visit made by a woman to her doctor after conception is commonly known as a “booking visit”. A detailed introduction is made as well as the pregnancy is tracked well in time which can spare a lot of energy, and resources and most of all the health of the mother and child has a better outcome.

Ideal time

It should be done as soon as she discovers she is pregnant. Ideally, around 6 to 8 weeks of her gestation when an initial examination and investigations including a dating scan can be done.

Components of the form

They are divided into different sections.

1. Introduction

  1. The name of the obstetrician/ midwife is written in the topmost section for the sake of convenience in her subsequent visits.
  2. Patient’s name, husband’s name, age, address, ethnicity, contact, or any other relevant information.

2. Dates

  1. Date the exam/checkup.
  2. Date of her last menstrual period commonly abbreviated as LMP. This is very important because her expected date of delivery and gestational age is calculated from this. Also, the age of her fetus and its development is estimated and correlated with examination and investigation.

3. Previous obstetric history

 This includes

  1. Gravidity which means if this is her first pregnancy or second or whatever, we have to mention it.
  2. Parity includes a number of the alive babies she already has. If this is her first pregnancy, we mention it as Zero.
  3. Miscarriages if any are also mentioned in number along with the age at which she miscarried her child is very important.
  4. In past pregnancies, any complications that occurred are also mentioned along with the mode of delivery of her child. Either the baby was delivered normally or via C-section or instruments.
    1. The general condition of the babies born is mentioned, and their sex, weight at birth, and any congenital anomalies if present are also asked and mentioned.

4. Gynecological history

Gynecological history is very significant whether a woman is pregnant or not. The main questions we need to ask her are,

  1. Nature, duration, and time of her menstrual cycle
  2. Any modes of contraception used by her
  3. If her pap smear was done or not. It is important because a pap smear is done to diagnose various infectious and non-infectious diseases including cervical carcinoma
  4. Any other gynecological issue she faced in the past

5. Medical and surgical history

  1. Generally, we ask if she suffered from diabetes, hypertension, cancer, liver or lung disease other than pregnancy in the past or underwent any surgery for any reason.
  2.  Blood group and hepatitis B and C status are mentioned 
  3. Any history of transfusion or its components
  4. We always ask if she has any allergies to any drug, food, season, or anything she wants to mention. This is very important because we do have to administer various drugs when needed and we must have a proper knowledge of everything about patients.
  5. If she is currently taking any medicines or not

6. Follow-up instructions

In the end, we have to give her instructions for home, which medicines to take, what precautions she needs in the future, and when to come again for her next visit or any investigations if needed.

Antenatal booking visit form
Antenatal booking visit form PDF

Simi Karton

Dr. Simi Karton currently resides in Los Angeles with her husband. This website is a voluntary work of Dr. Karton to provide people with useful health-related information with a straightforward approach.

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