i Pregnancy resulted from 1st Prenatal Care Record under: Artificial insemination – Medical history any fertility enhancing Intrauterine insemination Current pregnancy history medications including but not drugs, artificial Problem list or—initial risk limited to: insemination or intrauterine assessment Clomid insemination Clomiphene Medications this pregnancy Serophene Pergonal\ 2nd Labor and Delivery Nursing Metrodin Profasi Admission Triage Form Progesterol (not under: Comments progesterone) Medications Crinone (progesterone gel) Follistim 3rd Admission H&P under: FSH (follicle stimulating hormone) Current pregnancy history Gonadotopins Problem list/findings HcG (human chorionic gonadotropin Pergonal
i – Pregnancy resulted from any fertility enhancing drugs, artificial insemination or intrauterine insemination 1st Prenatal Care Record under: Medical history Current pregnancy history Problem list or—initial risk assessment Medications this pregnancy 2nd Labor and Delivery Nursing Admission Triage Form under: Comments Medications 3rd Admission H&P under: Current pregnancy history Problem list/findings Artificial insemination Intrauterine insemination medications including but not limited to: Clomid Clomiphene Serophene Pergonal\ Metrodin Profasi Progesterol (not progesterone) Crinone (progesterone gel) Follistim FSH (follicle stimulating hormone) Gonadotopins HcG (human chorionic gonadotropin Pergonal
Guide_MPM_BC_Facility_Worksheet_Guidelines.10.14.docx