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Research College of Nursing Mother-Baby Care …

Research College of Nursing Mother-Baby care report (Hand-off) Form S MOM Patient _____ Room _____ HC Provider _____ Staff RN _____ Date of care _____ Student _____. Age _____ Del. Date/Time _____ SVD or C/S ____(C/S indication) _____ Gravida ____ Para ____ AB ____ LC ____. B Bld Type/Rh _____ Rubella (imm/nonimm) Hep Screen(+/-) Group B Strep(+/-) treated? (antibiotics/#doses) _____/_____. Allergies _____ History/Complications _____ Lab ordered (postpartum Hgb & Hct) _____/_____. A Fundus _____ Lochia _____ Perineum/Incision _____ (REEDA, tears/lacerations/epis) Breasts/Nipples _____. Dressing _____ Voiding/Foley _____ IV/Lock/Site _____ I&O _____/_____ Activity _____ Diet _____ tDap/Rhogam VS: B/P_____T_____P_____R_____ Breath sounds _____ Bowel/flatus/ BM Last Pain Meds (time)/Score _____/_____ Discharge Date _____.

Research College of Nursing Mother-Baby Care Report (Hand-off) Form S MOM Patient _____ Room _____ HC Provider _____ Staff …

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