Department of Pediatrics
Philippine General Hospital
University of the Philippines Manila
The Health Sciences Center
Taft Avenue, Ermita, Manila
“PHIC Accredited Health Care Provider”
Department of Pediatrics
Philippine General Hospital
University of the Philippines Manila
The Health Sciences Center
Taft Avenue, Ermita, Manila
“PHIC Accredited Health Care Provider”
Baby _____ of __________________________________
Date of birth: ___________________________________
Date of discharge: _______________________________
Baby _____ of __________________________________
Date of birth: ___________________________________
Date of discharge: _______________________________
DIAGNOSIS
_____ term, ___ weeks by pediatric aging, ______ grams
________________ for gestational age, ______________
presentation via _________________________________
live baby ______, APGAR score ______
DIAGNOSIS
_____ term, ___ weeks by pediatric aging, ______ grams
________________ for gestational age, ______________
presentation via _________________________________
live baby ______, APGAR score ______
PLAN
___ daily warm bath, daily cord care with 70% isopropyl
alcohol, daily sunlight exposure
___ continue breastfeeding
___ continue medicines
___ for newborn screening
___ for hearing screen
PLAN
___ daily warm bath, daily cord care with 70% isopropyl
alcohol, daily sunlight exposure
___ continue breastfeeding
___ continue medicines
___ for newborn screening
___ for hearing screen
FOLLOW-UP at
___ LHC after 2 days
___ continuity clinic of Dr. _________ on _____________
___ high risk clinic, OPD room 238
FOLLOW-UP at
___ LHC after 2 days
___ continuity clinic of Dr. _________ on _____________
___ high risk clinic, OPD room 238
Department of Pediatrics
Philippine General Hospital
University of the Philippines Manila
The Health Sciences Center
Taft Avenue, Ermita, Manila
“PHIC Accredited Health Care Provider”
Department of Pediatrics
Philippine General Hospital
University of the Philippines Manila
The Health Sciences Center
Taft Avenue, Ermita, Manila
“PHIC Accredited Health Care Provider”
Baby _____ of __________________________________
Date of birth: ___________________________________
Date of discharge: _______________________________
Baby _____ of __________________________________
Date of birth: ___________________________________
Date of discharge: _______________________________
DIAGNOSIS
_____ term, ___ weeks by pediatric aging, ______ grams
________________ for gestational age, ______________
presentation via _________________________________
live baby ______, APGAR score ______
DIAGNOSIS
_____ term, ___ weeks by pediatric aging, ______ grams
________________ for gestational age, ______________
presentation via _________________________________
live baby ______, APGAR score ______
PLAN
___ daily warm bath, daily cord care with 70% isopropyl
alcohol, daily sunlight exposure
___ continue breastfeeding
___ continue medicines
___ for newborn screening
___ for hearing screen
PLAN
___ daily warm bath, daily cord care with 70% isopropyl
alcohol, daily sunlight exposure
___ continue breastfeeding
___ continue medicines
___ for newborn screening
___ for hearing screen
FOLLOW-UP at
___ LHC after 2 days
___ continuity clinic of Dr. _________ on _____________
___ high risk clinic, OPD room 238
FOLLOW-UP at
___ LHC after 2 days
___ continuity clinic of Dr. _________ on _____________
___ high risk clinic, OPD room 238
Department of Pediatrics
Philippine General Hospital
University of the Philippines Manila
The Health Sciences Center
Taft Avenue, Ermita, Manila
“PHIC Accredited Health Care Provider”
NURSERY RESIDENT’S NOTES
Date of birth: ______________________
Time of birth: _________________ AM/PM
Born ____ weeks by amenorrhea/early ultrasound to _________________, aged ___ years, G__P__ (
Pertinent maternal history
( ) PNCU
( ) UTI
( ) cough and colds
( ) fever / rash
( ) hypertension
( ) DM/GDM
( ) ruptured BOW
Time: _______
( ) premature labor, possibly due to: __________________
APGAR score
1 minute _____
5 minutes _____
10 minutes _____
(
(
(
(
) BA
) PTB
) smoking
) meconium (thick/thin)
( ) suctioning
( ) thermoregulation
( ) tactile stimulation
-
-
-
( ) PROM x ___ hrs
( ) heart disease
( ) alcohol
) after ____ hours of labor
( ) Dexa x ___ doses
( ) hepatitis B
( ) drugs
( ) PPV by face mask
( ) O2 inhalation
( ) intubation with PPV
Assessment
____ TERM, ____ WEEKS BY PEDIATRIC AGING, _______ GRAMS, __________ FOR GESTATIONAL AGE,
___________ PRESENTATION DELIVERED VIA ______________________________________________
LIVE BABY _______, APGAR SCORE ______
____________________
Resident’s signature
Department of Pediatrics
Philippine General Hospital
University of the Philippines Manila
The Health Sciences Center
Taft Avenue, Ermita, Manila
“PHIC Accredited Health Care Provider”
NURSERY RESIDENT’S NOTES
Date of birth: ______________________
Time of birth: _________________ AM/PM
Born ____ weeks by amenorrhea/early ultrasound to _________________, aged ___ years, G__P__ (
Pertinent maternal history
( ) PNCU
( ) UTI
( ) cough and colds
( ) fever / rash
( ) hypertension
( ) DM/GDM
( ) ruptured BOW
Time: _______
( ) premature labor, possibly due to: __________________
APGAR score
1 minute _____
5 minutes _____
10 minutes _____
(
(
(
(
) BA
) PTB
) smoking
) meconium (thick/thin)
( ) suctioning
( ) thermoregulation
( ) tactile stimulation
-
-
-
( ) PROM x ___ hrs
( ) heart disease
( ) alcohol
) after ____ hours of labor
( ) Dexa x ___ doses
( ) hepatitis B
( ) drugs
( ) PPV by face mask
( ) O2 inhalation
( ) intubation with PPV
Assessment
____ TERM, ____ WEEKS BY PEDIATRIC AGING, _______ GRAMS, __________ FOR GESTATIONAL AGE,
___________ PRESENTATION DELIVERED VIA ______________________________________________
LIVE BABY _______, APGAR SCORE ______
____________________
Resident’s signature
Department of Pediatrics
Philippine General Hospital
University of the Philippines Manila
The Health Sciences Center
Taft Avenue, Ermita, Manila
“PHIC Accredited Health Care Provider”
Cephalometry
BT
BP
OF
OM
SOB
NEWBORN RECORD
Name: _________________________
Case No. ________________________
Baby of: ________________________
Mother’s case no. ________________
Date of birth: ____________________
Time of birth: ____________________
Address: ________________________________________________________________________
EYES
CONJUNCTIVAE
SCLERAE
PUPILS
DISCHARGE
CHEST
NECK
MOUTH
EARS
NOSE
LIPS
TONGUE
PALATE
OTHERS
SCM
FISTULA
OTHERS
CLAVICLES
RESPIRATION
BREAST
LUNGS
HEART
ABDOMEN
MALE GENETILIA
FACE
ADMISSION PE
FEMALE
GENITALIA
HEAD
MOULDING
SCALP
FONTANELLES
SUTURES
Good
(-)
(-)
(-)
(-)
Open, soft, flat
(-) overlap
(-) dysmorphism
Pink
Anicteric
EBRTL
(-)
Formed
Formed
Formed
Formed
(-) cleft
(-)
Good tone
(-)
(-)
(-) fracture
ECE, CBS,
(-) retractions
E/N
ECE, CBS
DHS, NRRR
(-) murmurs, AP
Total
PA
SGA
AGA
LIVER
SPLEEN
KIDNEYS
UMBILICAL CORD
UMBILICAL HERNIA
DIASTASIS RECTI
OTHERS
PENILE SHAFT
HYPOSPADIA
CHORDEE
ABNORMALITIES
DISCHARGE
BLEEDING
Nonpalpable
Nonpalpable
Nonpalpable
2A / 1V
(-)
(-)
(-)
Straight
(-)
(-)
R – descended
L – descended
(-)
(-)
(-)
ABNORMALITIES
(-)
TESTIS
POLYDACTYLY
SYNDACTYLY
CLUBFOOT
HIP DISLOCATION
FEMORAL PULSES
SPINE
ANUS
CRY
MORO
SUCKING
ROOTING
GRASPING
TONIC
CHVOSTEK
DEEP REFLEXES
(-)
(-)
(-)
(-)
Full and equal
Straight
Patent
Good
(+)
(+)
(+)
(+)
(+)
(-)
2+
____ TERM, ____ WEEKS BY PEDIATRIC AGING, _______ GRAMS, ________________
FOR GESTATIONAL AGE, ___________ PRESENTATION DELIVERED VIA ___________
_________________________________, LIVE BABY _______, APGAR SCORE ______
LGA
DISCHARGE PE
HEAD CIRCUMFERENCE (cm)
CHEST/AB CIRCUM. (cm)
EXTREMITIES
SKIN
DESQUAMATION
Stable
Good
DISCHARGE PE
NEUROLOGIC
ADMISSION PE
DATE/TIME
GENERAL CONDITION
MUSCLE TONE
WEIGHT (GRAMS)
LENGTH (CM)
COLOR
TURGOR
RASH
Ballard
NM PM
____________________
Resident’s signature
Department of Pediatrics
Philippine General Hospital
University of the Philippines Manila
The Health Sciences Center
Taft Avenue, Ermita, Manila
“PHIC Accredited Health Care Provider”
Baby ____ of ________________________________
Date of birth: _______________________________
Time of birth: _________________________AM/PM
ADMITTING ORDERS
Date: ______________
Assessment
__________ term
__________ weeks by PA
__________ grams
__________________ for gestational age
__________________ presentation
Delivered via ______________________
Live baby __________
APGAR score _______
 Admit to _______________ under the service of
_______________________________________
 Secure consent for admission and management
 Please administer newborn care
 Daily warm bath
 Daily cord care with 70% isopropyl alcohol
 Eye prophylaxis with erythromycin eye ointment
 Vitamin K 1mg IM
 Diagnostics:
 Newborn screening on the 24th-48th hour of life
( ) meconium
( ) urine output
(
(
(
(
(
(
) thermoregulation
) suctioning
) tactile stimulation
) O2 inhalation
) PPV by face mask
) intubation with PPV
 Therapeutics
 Hepatitis B Vaccine (10μg/0.5mL) 0.5mL IM
HR: ________
RR: ________
Temp: ______
 Encourage breastfeeding with stric aspiration precautions
 Keep patient well-thermoregulated (36.7-37.5oC)
 Watch out for respiratory distress, poor suck, poor activity,
early jaundice, fever
 Inform AP/ROD/Fellow on duty of this admission
 Refer accordingly
________________________
Signature over printed name