"Pregnancy Journal Template - 1-8 Weeks Doctor Visit"

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Doctor Visit
1 – 8 Weeks
Physician or Midwife:
First Exam:
Date of Last Period:
Projected Due Date:
Previous Pregnancies
No. of Pregnancies:
No. of Live Births:
Birth Defects
Details:
Genetic Disorders
Details:
C-Sections
Details:
Abortions/Miscarriages
Details:
Pap Smear
Last Pap Smear:
Next Pap Smear:
Abnormal Cells
Details:
Gynecological Issues
Details:
Culture Check
Details:
Medical History
Blood Test Date:
Blood Type:
Rh Status:
Anemia
Syphilis
Hepatitis B
Rubella
HIV Status:
Immune to Chicken Pox?
Chronic Conditions:
Acute Conditions:
Medications:
Allergies:
Depression/Anxiety:
Things to Do
Prenatal Vitamins:
Food to Eat:
Exercises to Do:
Warning Signs:
Questions for Next Appt.
www.FreePrintableMedicalForms.com
Doctor Visit
1 – 8 Weeks
Physician or Midwife:
First Exam:
Date of Last Period:
Projected Due Date:
Previous Pregnancies
No. of Pregnancies:
No. of Live Births:
Birth Defects
Details:
Genetic Disorders
Details:
C-Sections
Details:
Abortions/Miscarriages
Details:
Pap Smear
Last Pap Smear:
Next Pap Smear:
Abnormal Cells
Details:
Gynecological Issues
Details:
Culture Check
Details:
Medical History
Blood Test Date:
Blood Type:
Rh Status:
Anemia
Syphilis
Hepatitis B
Rubella
HIV Status:
Immune to Chicken Pox?
Chronic Conditions:
Acute Conditions:
Medications:
Allergies:
Depression/Anxiety:
Things to Do
Prenatal Vitamins:
Food to Eat:
Exercises to Do:
Warning Signs:
Questions for Next Appt.
www.FreePrintableMedicalForms.com