1st Physician Progress Note ICU (intensive care unit) f - Admission to an intensive care unit MICU (medical intensive care unit) 2nd Transfer Note Any admission, planned or SICU (surgical intensive care unplanned, of the mother to a unit) facility or unit designated as providing intensive care. g - Unplanned operating room 1st Physician Operative Note Repair of laceration Repair of laparotomy procedure following delivery 2nd Physician Progress Note Drainage of purulent/septic Any transfer of the mother back to material a surgical area for an operative Exploratory laparotomy 3rd Physician Order procedure that was not planned before the admission for delivery. Excludes postpartum tubal ligations. Medical Record Number: Insert identifying medical chart number 27. Infant’s infant’s 28. Birthweight or Weight of Fetus Definitions Instructions Sources Key words/Abbreviations The weight of the infant at birth Enter the weight (in grams) of the 1st Delivery Record under - BW Birthweight – infant at birth. Infant Data Gms grams – kg - kilograms Do not convert pounds and ounces lbs - pounds oz ounces 2nd Admission Assessment under – (lbs. and oz.) to grams. - Weight If the weight in grams is not available, enter the birth weight in lbs. and oz.
f - Admission to an intensive care unit Any admission, planned or unplanned, of the mother to a facility or unit designated as providing intensive care. 1st Physician Progress Note 2nd Transfer Note ICU (intensive care unit) MICU (medical intensive care unit) SICU (surgical intensive care unit) g - Unplanned operating room procedure following delivery Any transfer of the mother back to a surgical area for an operative procedure that was not planned before the admission for delivery. Excludes postpartum tubal ligations. 1st Physician Operative Note 2nd Physician Progress Note 3rd Physician Order Repair of laceration Repair of laparotomy Drainage of purulent/septic material Exploratory laparotomy 27. Infant’s Medical Record Number: Insert infant’s identifying medical chart number 28. Birthweight or Weight of Fetus Definitions Instructions Sources Key words/Abbreviations The weight of the infant at birth Enter the weight (in grams) of the infant at birth. Do not convert pounds and ounces (lbs. and oz.) to grams. If the weight in grams is not available, enter the birth weight in lbs. and oz. 1st Delivery Record under - Infant Data 2nd Admission Assessment under - Weight BW – Birthweight Gms – grams kg - kilograms lbs - pounds oz – ounces
Guide_MPM_BC_Facility_Worksheet_Guidelines.10.14.docx