Best Start Pregnancy

Mother's Details
Pregnancy
Obstetric history
Medical history
Support
Exam/screening
Medicines
Vaccination
Care Planning
Actions
2nd Trimester

Over the last two weeks, have you been bothered by:

Over the last two weeks, have you been bothered by:

BP from PMS for last 12 months displayed here

Complete blood count
Blood group, Rhesus factor and antibodies
Rubella antibody status
Hepatitis B serology
Syphilis serology; for more information, see: BPAC information on syphilis
HIV (the Ministry of Health recommends that all pregnant women be routinely offered HIV testing)
HbA1c
Ferritin

List of long term medications and anything prescribed in the last 6 months to go here and user can select which medications are relevant.

	"Vaccination" tab
	"Vaccination" tab
	"Care Planning" tab
	"Care Planning" tab
	"Actions" tab

Information about this woman's pregnancy has been submitted previously by .

Recall date:

Best-Start Pregnancy Assessment

Prepared by: Dr Fred Smith on

Name:		DOB:
NHI:		Address:
		DHB:
		Enrolled Practice:

This pregnancy:

Previous obstetric history:

G: P:

Previous births

Medical history:

Previous/Ongoing Problems	Personal or Family Genetic Conditions

Mental health history

Wrap Around Support Assessment

SFV+

Alcohol AUDIT-C:

Other Drugs

Examination and Screening

STI Symptoms suggestive of STI:

Routine Screening

Medications

Current Medications:

Vaccinations

Care Planning

This practice is not yet authorised to access the Best Start Pregnancy application.

To authorise this practice, please enter the authorisation key provided:

If you do not know the authorisation key, please contact the NHC Help Desk.

Select the reporting group for this practice:

NHI Number:
Date of birth:

Referral from Best Start Pregnancy Assessment

Email pregnancy summary to:

I have discussed the security and privacy implications of sending this information by email with the mother and have received her consent to send this information by email to the above recipient.