Get the free Maternal Physical Examination (DHHS 3964) - Women's Health ...

1. Last Name First Name MI 2. Patient Number 3. Date of Birth (MM/DD/YYY) Month Day Year American Indian or Alaska Native Asian Black/African American Native Hawaiian/Other Panic Islander Unknown

How to fill out maternal physical examination dhhs

How to fill out maternal physical examination DHHS:

1. Obtain the maternal physical examination form from the DHHS website or local healthcare provider.
2. Start by filling in the personal and contact information of the pregnant individual, including their name, date of birth, address, and phone number.
3. Provide relevant medical history information, including any previous pregnancies, medical conditions, allergies, surgeries, or medications currently being taken.
4. Fill in the details about the current pregnancy, including the estimated due date, date of last menstrual period, and any complications or concerns.
5. Provide information about the healthcare provider or obstetrician overseeing the pregnancy, including their name, contact information, and any previous visits or appointments related to the pregnancy.
6. Mention any prenatal vitamins or supplements being taken and their dosages.
7. Provide a detailed family medical history, including any genetic disorders or hereditary diseases that may be pertinent to the pregnancy.
8. Answer questions regarding lifestyle factors such as smoking, alcohol or drug use, exercise routine, and any exposure to environmental hazards.
9. Fill out the physical examination section, including vital signs such as blood pressure, heart rate, and weight. Document any physical abnormalities or concerns observed during the examination.
10. Include any laboratory test results or diagnostic reports related to the pregnancy, if available.
11. Review the completed form for accuracy and completeness before submitting it to the DHHS or healthcare provider.

Who needs maternal physical examination DHHS?

1. Pregnant individuals who are seeking prenatal care or planning to deliver their baby in a DHHS-approved facility.
2. Women with high-risk pregnancies or specific medical conditions that require additional monitoring or specialized care.
3. Individuals who are eligible for government-funded healthcare programs and need to fulfill the necessary requirements for coverage.
4. Pregnant individuals who want to ensure the health and well-being of themselves and their unborn child by undergoing a comprehensive physical examination.

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What is maternal physical examination dhhs?

Maternal physical examination dhhs is a required form that collects information about a mother's health status during and after pregnancy.

Who is required to file maternal physical examination dhhs?

Healthcare providers who are providing care to pregnant women are required to file maternal physical examination dhhs.

How to fill out maternal physical examination dhhs?

Maternal physical examination dhhs can be filled out by healthcare providers by documenting the relevant details of the mother's physical health during and after pregnancy.

What is the purpose of maternal physical examination dhhs?

The purpose of maternal physical examination dhhs is to monitor and track the health status of pregnant women to ensure the well-being of both the mother and the baby.

What information must be reported on maternal physical examination dhhs?

Information such as the mother's blood pressure, weight, medical history, any complications during pregnancy, and postpartum care are required to be reported on maternal physical examination dhhs.