"Pregnancy Journal Template - 21-27 Weeks Doctor Visit"

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Doctor Visit
21 – 27 Weeks
Physician or Midwife:
Fourth Exam:
Blood Pressure:
Changes?
Urine Sample:
Signs of Preeclampsia?
Weight:
Weight Gained:
Nausea?
Baby Movements:
Swelling in Hands:
Swelling in Feet:
Contractions:
Frequency:
Leaking Fluid:
Spotting/Bleeding:
Uterus Size:
Tested:
Vaginally
Belly
Ultrasound
Baby’s Heartbeat:
Growth Rate:
Tests Done
Pelvic Exam
Result:
Breast Exam
Result:
Pap Smear
Result:
Ultrasound
Result:
Doppler Scan
Result:
Blood Test
Result:
Glucose Screening Test
Result:
Things to Do
New Info:
Food to Eat:
Exercises to Do:
Classes to Take:
Books to Read:
Warning Signs:
Questions for Next Appt.
www.FreePrintableMedicalForms.com
Doctor Visit
21 – 27 Weeks
Physician or Midwife:
Fourth Exam:
Blood Pressure:
Changes?
Urine Sample:
Signs of Preeclampsia?
Weight:
Weight Gained:
Nausea?
Baby Movements:
Swelling in Hands:
Swelling in Feet:
Contractions:
Frequency:
Leaking Fluid:
Spotting/Bleeding:
Uterus Size:
Tested:
Vaginally
Belly
Ultrasound
Baby’s Heartbeat:
Growth Rate:
Tests Done
Pelvic Exam
Result:
Breast Exam
Result:
Pap Smear
Result:
Ultrasound
Result:
Doppler Scan
Result:
Blood Test
Result:
Glucose Screening Test
Result:
Things to Do
New Info:
Food to Eat:
Exercises to Do:
Classes to Take:
Books to Read:
Warning Signs:
Questions for Next Appt.
www.FreePrintableMedicalForms.com