Postnatal Visit

Postnatal Visit
# weeks postpartum:
**HISTORY**
Review Birth:

Baby's health/concerns:

Breastfeeding/concerns:
Bladder/Bowel Function:
Lochia/Menses:
Perineal discomfort:
Contraception:

Rubella immune Yes/No/Vaccinated:

Smoking History:
PAP status:
**PHYSICAL EXAMINATION**
Weight:
BP:
Affect:
Thyroid:
Breast Exam:
Abdomen:
Perineum:
Pelvic exam:
**DISCUSSION TOPICS**
Emotional problems/depression:

Contraception:
Sexual/relationship concerns:
Social support:
Family violence:
Follow-up and advice re: future pregnancies:
(e.g. folic acid, and risk for future pregnancies)