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Patient Name:Date:BIRTH HISTORY Please answer the following: Medications taken during pregnancy___ If pregnancy complicated, please explain___ Full TermYesNoPremature___weeks DeliveryVaginal___CesareanReason
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How to fill out birth history
How to fill out birth history
01
Contact the hospital or birthing center where the birth took place to request a copy of the birth history form.
02
Fill out the form with accurate information about the baby's birth, including details about the date and time of birth, the baby's weight and length at birth, and any complications during labor and delivery.
03
Be sure to include information about the mother's health history and any medications taken during pregnancy.
04
Submit the completed form to the appropriate healthcare provider or organization as requested.
Who needs birth history?
01
Healthcare providers including pediatricians, obstetricians, and midwives may need the birth history to provide appropriate care for the baby and mother.
02
Parents may also request a copy of the birth history for their own records or to share with other healthcare providers in the future.
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What is birth history?
Birth history is a record of details about a person's birth.
Who is required to file birth history?
Typically, parents or legal guardians are required to file birth history.
How to fill out birth history?
Birth history can be filled out by providing information about the date, time, location, and other details of the birth.
What is the purpose of birth history?
The purpose of birth history is to have a documented record of a person's birth for legal, medical, and historical purposes.
What information must be reported on birth history?
Information such as date of birth, time of birth, location of birth, weight at birth, and other relevant details must be reported on birth history.
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